Work hazards and workers’ mental health: an investigation based on the fifth European Working Conditions Survey

Background:Workplace hazards are a significant source of health impairment for workers and of financial losses for firms. EU directives on workers’ health and safety standards significantly contributed to reduce reported occupational injuries, yet the incidence and prevalence of work-related mental illness is still very high.Objectives:We investigated the association between work-related hazards and individuals’ perceived mental health. We reviewed the existing evidence on the channels through which task-related factors, adverse agents and psychosocial factors are expected to affect workers’ health, with specific regard to mental health.Methods:We used data from the fifth wave of the European Working Conditions Survey, covering over 40,000 face-to-face interviews with workers in 34 countries, which includes information on socio-demographic characteristics, firms and jobs attributes, employment status, as well as working conditions and health status. We carried out an empirical analysis with multivariate regression models in order to estimate the relationship between workers’ mental health problems and workplace risk factors.Results:21,020 interviews were used in the multivariate analysis. We found strong correlations between hazards and various indicators of mental health. Among hazardous agents, low temperatures (β=0.0287) and contact with infectious materials (β=0.0394) were positively associated with mental health outcomes. Among task/sequence-related factors, tiring or painful positions (β=0.0713), repetitive hand/arm movements (β=0.0255), working with VDUs (β=0.0301), repetitive tasks <10 min (β=0.0859) and working in evenings (β=0.00754) were positively associated with mental health. Various psychosocial risk factors related to both the content of the job (for example, frequent disruptive interruptions: β=0.219, working in free time: β=0.0759, poor work-life balance: β=0.228) as well as the job context (for example, bad employment prospects: β=0.177, low decisional autonomy: β=0.245, bad social relations: β=0.186, workplace violence: β=0.411) were positively associated with mental health. The main results of the decomposition show that an important contribution to workers’ overall mental distress at work is associated with psychosocial risk factors (up to 60% for depression/anxiety symptoms and sleep disorders), while the contribution of somatic factors is on average lower (up to 20% for overall fatigue).Conclusions:We argue that action is needed to improve workers’ mental well-being, and reduce the economic costs for both the national health system and employers. Regulations and traditional economic measures are unlikely to prove successful in providing adequate standards of primary and secondary preventive measures in the work place without an appropriate and reliable Risk Assessment Procedure.Key words: Work hazards, risk assessment, job content, mental health     

Types of employment and health in the European union: changes from 1995 to 2000

BACKGROUND: This study compares associations between types of employment and health indicators in the Second (ES1995) and the Third European Survey on Working Conditions (ES2000) by gender, adjusting for individual and country-level confounders. METHODS: Two cross-sectional surveys of a representative sample of the European Union (EU) total active population (n=15,146 workers in ES1995 and n=21,703 workers in ES2000). Based on their comparability in both surveys four health indicators were considered: job dissatisfaction, stress, fatigue and backache. RESULTS: Non-permanent employment reported high percentages of job dissatisfaction but low levels of stress. Small employers were more likely to report fatigue and stress but less likely to report job dissatisfaction. Sole traders were more likely to report fatigue and backache. Workers in full-time employment almost always reported worse levels of health indicators than part-time. Two exceptions for part-time were found: temporary employment regarding job dissatisfaction, and in ES2000, sole traders with regard to job dissatisfaction, fatigue and backache. By and large, results by gender were similar in both surveys, although the magnitude of associations decreased in ES2000. Associations remained unchanged after adjustment. CONCLUSION: This study has compared for the first time the associations between various types of employment and four health indicators for the EU in ES1995 and ES2000, by gender. Overall, a slight increase in all health indicators was observed in the ES2000 compared to ES1995, and results were very consistent between both surveys. Similar findings in both surveys suggest that causal interpretation may be enhanced.     

Precarious employment and health: analysis of the Comprehensive National Survey in Japan

Recent studies suggest that unstable employment contracts may affect the health of workers. Many Japanese workers working full time in ostensibly permanent positions actually operate within unstable and precarious employment conditions. We compared the health status of Japanese workers with precarious employment contracts with that of permanent workers using the 2007 Comprehensive Survey of Living Conditions of the People on Health and Welfare (n=205,994). We classified their employment status as 'permanent' vs. 'precarious' (part-time, dispatch, or contract/non-regular) and compared their health conditions. Among both sexes, precarious workers were more likely than permanent workers to have poor self-rated health or more subjective symptoms, with more workers in full-time employment suffering from serious psychological distress (SPD) and more female workers who smoke. Using logistic regression, we identified a positive association between precarious employment and SPD and current smoking among workers engaged in full-time employment after adjusting for age, marital status, and work-related conditions. This study demonstrates that precarious employment contracts are associated with poor self-rated health, psychological distress, and tobacco use, especially among people working full-time jobs. These results suggest that engagement in full-time work under unstable employment status impairs workers' health.     

Risk and resilience: health inequalities,working conditions and sickness benefit arrangements: an analysis of the 2010 European Working Conditions survey

In this article we ask whether the level of sickness benefit provision protects the health of employees, particularly those who are most exposed to hazardous working conditions or who have a little education. The study uses the European Working Condition Survey that includes information on 20,626 individuals from 28 countries. Health was measured by self‐reported mental wellbeing and self‐rated general health. Country‐level sickness benefit provision was constructed using spending data from Eurostat. Group‐specific associations were fitted using cross‐level interaction terms between sickness benefit provision and physical and psychosocial working conditions respectively, as well as those with little education. The mental wellbeing of employees exposed to psychosocial job strain and physical hazards, or who had little education, was better in countries that offer more generous sickness benefit. These results were found in both men and women and were robust to the inclusion of GDP and country fixed effects. In the analyses of self‐reported general health, few group‐specific associations were found. This article concludes that generous sickness benefit provision may strengthen employee's resilience against mental health risks at work and risks associated with little education. Consequently, in countries with a generous provision of sickness benefit, social inequalities in mental health are smaller.     

The effects of ill health on entering and maintaining paid employment: evidence in European countries

OBJECTIVES: To examine the effects of ill health on selection into paid employment in European countries. METHODS: Five annual waves (1994-8) of the European Community Household Panel were used to select two populations: (1) 4446 subjects unemployed for at least 2 years, of which 1590 (36%) subjects found employment in the next year, and (2) 57 436 subjects employed for at least 2 years, of which 6191 (11%) subjects left the workforce in the next year because of unemployment, (early) retirement or having to take care of household. The influence of a perceived poor health and a chronic health problem on employment transitions was studied using logistic regression analysis. RESULTS: An interaction between health and sex was observed, with women in poor health (odds ratio (OR) 0.4), men in poor health (OR 0.6) and women (OR 0.6) having less chance to enter paid employment than men in good health. Subjects with a poor health and low/intermediate education had the highest risks of unemployment or (early) retirement. Taking care of the household was only influenced by health among unmarried women. In most European countries, a poor health or a chronic health problem predicted staying or becoming unemployed and the effects of health were stronger with a lower national unemployment level. CONCLUSION: In most European countries, socioeconomic inequalities in ill health were an important determinant for entering and maintaining paid employment. In public health measures for health equity, it is of paramount importance to include people with poor health in the labour market.     

Poor health, employment transitions and gender: evidence from the British Household Panel Survey

Objectives

We examined health selection in the context of transitions across employment statuses (employment, unemployment and inactivity), with attention to gender differences.

Methods

60,536 transitions from 7,901 individuals were pooled from 17 waves of the British Household Panel Survey. Associations between self-rated health and transitions across employment statuses were examined using multilevel multinomial analysis.

Results

Health selective employment transitions between year t-1 and t were observed at entry to as well as exit from employment. Associations for poor health with the transitions were similar for men and women in transitions from employment to both unemployment and to inactivity, but with some differences in other transitions. When leaving employment, transitions from employment to unemployment (OR_adjusted(adjusted odds ratio) = 1.51, 95 % CI = 1.21–1.89 for men and OR_adjusted = 1.60, 95 % CI = 1.25–2.04 for women) and to inactivity (OR_adjusted = 1.58, 95 % CI = 1.21–1.89 for men and OR_adjusted = 1.63, 95 % CI = 1.35–1.96 for women) were affected by health status among both men and women. Similarly, poor health lowered the probability of transitions to employment from unemployment and inactivity; however, the negative impact of poor health was statistically significant only for women.

Conclusions

There is a strong relationship between health and transitions both into and out of employment suggesting an independent role for poor health, and these associations were similar for men and women.     

US health services employment: A time series analysis

The growth of health services employment in the United States is modelled using ARIMA analysis, and related to the growth in total U.S. employment. It is argued that specific features of the medical care sector (licensed professional manpower, non-profit firms, third-party financing) create institutional rigidities which delay adjustment to macroeconomic conditions and other shocks. Tests of Granger causality and the pattern of coefficients in the cross-correlation function show that health services employment does lag other sectors of the economy by an average of 2 to 4 years. A Box-Jenkins transfer-noise function model between total and health employment is constructed and evaluated, and the impact dynamics of adjustment to Medicare and Medicaid are estimated.     

Education and self-reported health care seeking behaviour in European welfare regimes: results from the European Social Survey

Objectives  

This study investigates educational inequalities in the perception of need for seeking health care in 24 European countries belonging to five different welfare regimes (Scandinavian, Anglo-Saxon, Bismarckian, Eastern and Southern).     

The effects of health shocks on employment and health insurance: the role of employer-provided health insurance

Employment-contingent health insurance (ECHI) has been criticized for tying insurance to continued employment. Our research sheds light on two central issues regarding employment-contingent health insurance: whether such insurance ??locks?? people who experience a health shock into remaining at work; and whether it puts people at risk for insurance loss upon the onset of illness, because health shocks pose challenges to continued employment. We study how men??s dependence on their own employer for health insurance affects labor supply responses and health insurance coverage following a health shock. We use the Health and Retirement Study (HRS) surveys from 1996 through 2008 to observe employment and health insurance status at interviews 2?years apart, and whether a health shock occurred in the intervening period between the interviews. All employed married men with health insurance either through their own employer or their spouse??s employer, interviewed in at least two consecutive HRS waves with non-missing data on employment, insurance, health, demographic, and other variables, and under age 64?at the second interview are included in the study sample. We then limited the sample to men who were initially healthy. Our analytical sample consisted of 1,582 men of whom 1,379 had ECHI at the first interview, while 203 were covered by their spouse??s employer. Hospitalization affected 209 men with ECHI and 36 men with spouse insurance. A new disease diagnosis was reported by 103 men with ECHI and 22 men with other insurance. There were 171 men with ECHI and 25 men with spouse employer insurance who had a self-reported health decline. Labor supply response differences associated with ECHI??with men with health shocks and ECHI more likely to continue working??appear to be driven by specific types of health shocks associated with future higher health care costs but not with immediate increases in morbidity that limit continued employment. Men with ECHI who have a self-reported health decline are significantly more likely to lose health insurance than men with insurance through a spouse. With the passage of health care reform, the tendency of men with ECHI as opposed to other sources of insurance to remain employed following a health shock may be diminished, along with the likelihood of losing health insurance.     

Monitoring health inequalities through general practice: the Second Dutch National Survey of General Practice

BACKGROUND: For the second time a plan to monitor public health and health inequalities in the Netherlands through general practice was put into action: the Second National Survey of General Practice (DNSGP-2, 2001). The first aim of this paper is to describe the general design of DNSGP-2. Secondly, to describe self assessed health inequalities in the Netherlands. Thirdly, to present differences in prevalence of chronic conditions by educational attainment using both self-assessed health and medical records of GPs. Finally, inequalities in 1987 (DNSGP-1) and 2001 will be compared. METHODS: Data were collected from 96 (1987) and 104 (2001) general practices. The data include background information on patients collected via a census, approximately 12,000 health interview surveys per time point and more than one million recorded contacts of patients with their GPs in both years. The method of statistical analysis is logistic regression. RESULTS: The analyses shows that the lower educated have significantly higher odds of feeling unhealthy and having chronic conditions in 2001. Diabetes and myocardial infarction (GP data) showed the largest difference in prevalence between educational groups (OR 2.5 and 2.4, self-reported data). The way the data is collected (self-assessment versus GP registration) hardly affects the magnitude of the educational differences in the prevalence of chronic conditions. The pattern of health inequalities across chronic conditions in 1987 and 2001 hardly differs. Diabetes doubled in prevalence and health inequalities were not significant in 1987, but compared to the other conditions were largest in 2001 (OR 1.1 versus 2.5). CONCLUSION: Health inequalities were shown to be substantial in 2001 and persistent over time. Socio-economic differences were shown to be similar using self-assessed health data and GP data. Hence, a person's educational attainment did not appear to play a part in presenting health problems to the GP.     

A causal analysis of employment and health in midlife women

According to the "healthy worker" hypothesis, good health selects women into the employment role; conversely, the social causation hypothesis argues that important social roles such as employment can contribute to health. The relationship between these two variables may be of special concern to women at midlife, as both issues become increasingly salient. In this paper a model hypothesizing a nonrecursive (reciprocal) causal relationship between employment (hours employed) and health was presented. Because of the importance of both employment and health for women at midlife, the model was tested in a sample of 463 women ages 40-64 from a national cross-sectional dataset. Two-stage least squares regression supported the hypothesis that employment and health have a positive reciprocal relationship for women at midlife. In addition, married women and those with a child had better health but were likely to work fewer hours for pay. The same model tested in 21 to 39-year-old women was not significant. The results serve to emphasize the importance of examining assumptions about direction of causality in research on work and well-being at midlife.     

女职工健康监护的调查分析

妇女有其自身的生理特点，而能干扰女性性腺分泌和作用于神经系统的职业有害因素都可以影响女性性功能。与男性相比，女性性功能与社会、心理的关系更为密切。 本企业女职工人数占职工总人数４５．３％，是企业内劳动力的重要组成部分，因此保护劳动妇女健康地参加各种生产劳动有着重要的社会经济意义。此文对企业内育龄妇女的健康监护资料进行分析，以便有针对性地开展职业妇女劳动保护工作。１对象与方法１．１对象本次调查总人数为 ８８４人，根据不同职业的育龄妇女分类为６组，年龄限在４５岁以Ｆ，工龄在２年以上见表１。１．２内容与…     

European integration and health policies: repercussions of the internal European Market on access to health services

This article explores the health policy repercussions of countries' regional integration into the European Union. The aim is to review the regulation of access in other countries, with the conclusion of the single European market and the free circulation of persons, services, goods, and capital. The article begins by reviewing the various forms of integration and describes the expansion and institutionalization of Community agencies. The repercussions of European integration on health policies and regulation of access are analyzed. Market impacts on health result from Treaty directives and internal policy adjustments to free circulation. Health services access is gradually regulated and granted by rulings. Projects along borders illustrate the dynamics where differences are used to achieve comprehensive care. In the oldest integration experience, the market regulation has generated intentional and non-intentional impacts on the health policies of member states, regardless of the organizational model. Knowledge and analysis of this experience signals challenges for the Southern Cone Common Market (Mercosur) and adds to future debates and decisions.     

Temporary employment and health: a review

OBJECTIVES: We aimed to review evidence on the relationship between temporary employment and health, and to see whether the association is dependent on outcome measure, instability of employment, and contextual factors. METHOD: We systematically searched for studies of temporary employment and various health outcomes and critically appraised 27 studies. RESULTS: The review suggests higher psychological morbidity among temporary workers compared with permanent employees. According to some studies, temporary workers also have a higher risk of occupational injuries but their sickness absence is lower. Morbidity may be higher in temporary jobs with high employment instability and in countries with a lower number of temporary workers and unemployed workers. CONCLUSIONS: The evidence indicates an association between temporary employment and psychological morbidity. The health risk may depend on instability of temporary employment and the context. Confounding by occupation may have biased some of the studies. Additional research to clarify the role of employment instability, hazard accumulation, and selection is recommended.     

实习护士就业意向调查

目的:了解实习护士的就业意向以及影响就业意向的因素.方法:对在绵阳市中心医院实习的将于2017年毕业的174名实习护士进行了不署名问卷调查结果:95.71%毕业后会选择护理工作.92.54%护士希望选择了50万人口以上的城市就业,96.27%护士毕业后希望选择三级医院就业,60.44%实习护士选择就业时首先考虑收入高.61.20%实习护士认为对最终就业影响最大的是个人能力.结论:绝大部分实习护士毕业后会选择护理工作;如果不受其他条件限制,绝大部分的护士希望选择三级医院和中等以上城市就业.实习护士认为对最终就业影响最大的是个人能力和文凭.性别、年龄、家庭居住状况、即将获得的文凭、学校所在城市大小对实习护士的选择有一定影响.     

The association between extent of employment and hypertension among women participants of the Second National Health and Nutrition Survey.

The association between extent of employment and hypertension was examined among 3,824 women participants of the Second National Health and Nutrition Examination Survey. Women in three employment groups (full-time, part-time, and short-term) were compared to homemakers. In covariate-adjusted, logistic regression models, women employed full-time had a somewhat lower, but not significantly different, prevalence of hypertension (OR = 0.8, 95% CI = 0.7, 1.1), whereas both part-time (OR = 0.6, 95% CI = 0.4, 0.7) and short-term (OR = 0.5, 95% CI = 0.4, 0.7) workers had significantly lower prevalences. Associations did not tend to vary by age, ethnicity, or occupation. Employment does not appear to increase the risk of hypertension in women; in fact, moderate levels were associated with lower risk.