Selection from fixed term to permanent employment: prospective study on health,job satisfaction,and behavioural risks

STUDY OBJECTIVE: To examine health, job satisfaction, and behavioural risks as antecedents of selection from fixed term to permanent employment. DESIGN: Prospective cohort study of change in employment contract during a two year period. Self reported health, recorded sickness absence, job satisfaction, behavioural risks, demographics, and occupational characteristics were assessed at baseline. SETTING: Hospital staff in two Finnish hospital districts. PARTICIPANTS: A cohort of 526 hospital employees (54 men, 472 women) aged 20 to 58 years with a fixed term job contract at baseline. Main results: During the follow up period, 137 became permanently employed. Men, employees in higher positions, full time workers, and those with five to eight years in the employ of the hospital were more likely to become permanently employed. After adjusting for these factors, obtaining a permanent job contract was predicted by self rated good health (odds ratio (OR) 3.90; 95% confidence intervals (CI) 1.34 to 11.36), non-caseness of psychological distress (OR 1.80; 95% CI 1.01 to 3.20), high job satisfaction (OR 1.86; CI 1.17 to 2.94), and non-sedentary life style (OR 2.64; CI 1.29 to 5.41), compared with the rest of the cohort. CONCLUSIONS: Investigation of fixed term employees yields new information about selective mechanisms in employment mobility. Good health seems to promote the chances for a fixed term employee to reach a better labour market status. These results correspond to earlier research on selective mechanisms in other forms of employment mobility and provide a partial explanation for the socioeconomic gradient of health.     

Social capital in working life and the health of employees

It is commonly assumed that social capital influences health, but only few studies have examined this hypothesis in the context of the workplace. The present prospective cohort study of 6028 public sector employees in Finland investigated social capital as a workplace characteristic which potentially affects employee health. The two indicators of social capital were trust in the labour market, measured by security of the employment contract, and trust in co-worker support. Self-rated health status and psychological distress were used as indicators of health. The combination of subsidised job contract and low co-worker support (i.e. the lowest category of social capital) was associated with poorer health prospects than the combination of permanent employment and high support (the highest social capital category) in an age-adjusted model, but this association disappeared in logistic regression analysis adjusted by sociodemographic background factors and baseline health. Fixed-term employment predicted better self-rated health and less psychological distress when compared with permanent employment. Co-worker support was most common in permanent and least common in subsidised employees and it was associated with better self-rated health in women. Our findings suggest only partial support for the hypothesis of work-related social capital as a health resource.     

From insecure to secure employment: changes in work, health, health related behaviours, and sickness absence

Aims: To determine whether change in employment status (from fixed term to permanent employment) is followed by changes in work, health, health related behaviours, and sickness absence.

Methods: Prospective cohort study with four year follow up. Data from 4851 (710 male, 4141 female) hospital employees having a fixed term or permanent job contract on entry to the study were collected at baseline and follow up.

Results: At baseline, compared to permanent employees, fixed term employees reported lower levels of workload, job security, and job satisfaction. They also reported greater work ability. All fixed term employees had a lower rate of medically certified sickness absence at baseline. Baseline rate ratios for those who remained fixed term were 0.64 (95% CI 0.55 to 0.75), and were 0.50 (95% CI 0.34 to 0.75) for those who later became permanent. Continuous fixed term employment was not associated with changes in the outcome measures. Change from fixed term to permanent employment was followed by an increase in job security, enduring job satisfaction, and increased medically certified sickness absence (compared to permanent workers rate ratio 0.96 (95% CI 0.80 to 1.16)). Other indicators of work, health, and health related behaviours remained unchanged.

Conclusion: Receiving a permanent job contract after fixed term employment is associated with favourable changes in job security and job satisfaction. The corresponding increase in sickness absence might be due to a reduction in presenteeism and the wearing off of health related selection.

     

Psychosocial factors and work related sickness absence among permanent and non-permanent employees

STUDY OBJECTIVE: To examine the association between psychosocial work factors and work related sickness absence among permanent and non-permanent employees by sex. DESIGN: A cross sectional survey conducted in 2000 of a representative sample of the European Union total active population, aged 15 years and older. The independent variables were psychological job demands and job control as measures of psychosocial work environment, and work related sickness absence as the main outcome. Poisson regression models were used to compute sickness absence days' rate ratios. SETTING: 15 countries of the European Union. PARTICIPANTS: A sample of permanent (n = 12 875) and non-permanent (n = 1203) workers from the Third European Survey on Working Conditions. RESULTS: High psychological job demands, low job control, and high strain and passive work were associated with higher work related sickness absence. The risks were more pronounced in non-permanent compared with permanent employees and men compared with women. CONCLUSIONS: This work extends previous research on employment contracts and sickness absence, suggesting different effects depending on psychosocial working conditions and sex.     

Social inequalities in the impact of flexible employment on different domains of psychosocial health

STUDY OBJECTIVES: (1) To analyse the impact of flexible employment on mental health and job dissatisfaction; and (2) to examine the constraints imposed by flexible employment on men's and women's partnership formation and people's decision to become parents. For the two objectives the potentially different patterns by sex and social class are explored. DESIGN: Cross sectional health survey. Multiple logistic regression models separated for sex and social class (manual and non-manual workers) and controlling for age were fitted. Four types of contractual arrangements have been considered: permanent, fixed term temporary contract, non-fixed term temporary contract, and no contract. SETTING: Catalonia (a region in the north east of Spain). PARTICIPANTS: Salaried workers interviewed in the 2002 Catalonian health survey with no longstanding limiting illness, aged 16-64 (1474 men and 998 women). MAIN RESULTS: Fixed term temporary contracts were not associated with poor mental health status. The impact of other forms of flexible employment on mental health depended on the type of contractual arrangement, sex, and social class and it was restricted to less privileged workers, women, and manual male workers. The impact of flexible employment on living arrangements was higher in men. Among both manual and non-manual male workers, those with fixed term temporary contracts were less likely to have children when married or cohabiting and, additionally, among non-manual male workers they also were more likely to remain single (aOR = 2.35; 95%CI = 1.13 to 4.90). CONCLUSION: Some forms of temporary contracts are related to adverse health and psychosocial outcomes with different patterns depending on the outcome analysed and on sex and social class. Future research should incorporate variables to capture situations of precariousness associated with flexible employment.     

Employment transitions and mental health: an analysis from the British household panel survey

STUDY OBJECTIVE: To describe the impact of changes between employment and various forms of non-employment, and vice versa, on the psychological wellbeing of men and of women. DESIGN: Separate multivariate models for men and for women were constructed to study the association between employment transitions and episodes of psychological distress (general health questionnaire). PARTICIPANTS: 13,359 employment transitions from 5092 people aged 16-74 years in the British household panel survey from 1991 to 1998. MAIN RESULTS: Transitions from paid employment to either unemployment or long term sick leave were associated with increased psychological distress for both men and women. Starting maternity leave or staying home to look after the family were also associated with psychological distress for women. Transitions from these roles to formal employment resulted in an improvement in mental health. There was some evidence that the effects were felt most strongly within six months of the transition. CONCLUSIONS: This paper provides further evidence that movements between paid employment and various forms of non-employment, in addition to unemployment, have an impact on mental health. The emphasis on transitions between a full range of employment states for both men and women from a large population based longitudinal study and a comparison of the relative magnitude of effects are unique features of this analysis. Interventions are suggested to minimise the psychological distress associated with transitions.     

Effect of employee worktime control on health: a prospective cohort study

Aims: To investigate the health effects of employee worktime control.

Methods: Prospective cohort study among 4218 permanent full time municipal employees linking questionnaire data from 1997 and 2000 with sickness absence records from 1997 and 2001. Worktime control was considered high for the highest tertile in both 1997 and 2000, low for the lowest tertile for both years, and intermediate for all other combinations. Self rated health status, psychological distress, and medically certified periods of sickness absence were used as the health outcomes. Adjustments were made for age, baseline health status, occupational status, marital status, dependent children, and behavioural health risks.

Results: In the follow up, women with a low level of worktime control had a 1.9 times (95% CI 1.4 to 2.5) higher odds ratio for poor self rated health, a 1.4 times (95% CI 1.1 to 1.8) higher odds ratio for psychological distress, and a 1.5 times (95% CI 1.3 to 1.7) higher risk of medically certified sickness absences than women with a high level of worktime control. The health effects of worktime control were particularly evident among women with families. Among men, worktime control was not associated with self rated health or distress, but it predicted sickness absences in two subgroups: those with dependent children and those with manual occupations.

Conclusions: A low level of worktime control increases the risk of future health problems. The risk is highest among women, especially those with families, and among manual workers. The results suggest that worktime control can help workers integrate their work and private lives successfully.

     

Do overeducated individuals have increased risks of ill health?: a Swedish population‐based cohort study

Previous studies indicate that the increasing educational level in many post‐industrial nations may imply that subgroups of the population work in occupations for which they are overeducated. We aimed to investigate whether overeducation is associated with future self‐rated health and psychological distress. The analytical sample consisted of 21,159 participants from the Stockholm Public Health Cohort. Individuals with upper secondary or university education, who in 2006 or 2007 had occupations requiring less education, were considered overeducated. The outcomes were self‐rated health (SRH) and psychological distress in 2010. Overeducated women had an increased risk of less than good SRH, compared to university‐educated women in matching occupations (adjusted odds ratios (OR): 2.44 confidence intervals (CI): 1.32–4.51 for overeducated women with secondary school education), but not compared to less educated women in the same occupational class (adjusted OR: 0.87 CI:0.32–2.38 for overeducated women with secondary school education). We found no increased risk of less than good SRH for overeducated men, and no association between overeducation and psychological distress for either sex. The results indicate that overeducation is not per se associated with onset of less than good SRH or psychological distress in a short‐term perspective, and the findings support education expansion as a means of improving public health.     

Health inequalities in the workforce: the labour market core-periphery structure

OBJECTIVES: To explore health inequalities between six labour market groups ranging from permanent employees to the long-term unemployed receiving minimum daily allowance. METHODS: A sample of 15 468 employees or job seekers from a population survey. Their perceived health, diseases, and depression were measured. RESULTS: Compared with permanent employees, the odds for poor health were highest among the unemployed with low incomes irrespective of adjustments, across all health indicators and in both men and women. High odds were also found among the less disadvantaged unemployed and the employed with atypical contracts, but not among fixed-term employees. CONCLUSIONS: Rather than between the employed and the unemployed, it seems that health inequalities prevail across different labour market groups within the employed and the unemployed. Future studies should employ a more detailed classification of employment situation.     

Suboptimal health as a predictor of non-permanent employment in middle age: a 12-year follow-up study of the Northern Swedish Cohort

Purpose

Earlier research on health-related selection in the labour market has concentrated on selection of those with poor health into unemployment. The purpose of the present study was to investigate if suboptimal health also predicts non-permanent employment.

Methods

A population cohort of 517 men and 477 women was surveyed at age 30 and at age 43 about their health and yearly employment. Non-permanent employment during the follow-up was assessed for its occurrence with Cox regression and for the amount (accumulation in months) with generalised linear models.

Results

Suboptimal self-rated health, sense functioning and sleep quality in women and suboptimal mood in men predicted high accumulation of non-permanent employment. By contrast, in men, suboptimal self-rated health and sense functioning predicted low accumulation. The gender differences were statistically significant. Smoking predicted high occurrence and accumulation of non-permanent employment equally in men and women, whereas no associations were seen with overweight and alcohol consumption.

Conclusions

Selection into non-permanent employment was shown for several indicators of suboptimal health. A gendered pattern was found, with more health selection among women. The findings of this pioneering study should be tested with further research.     

Psychological distress among Kurdish immigrants in Sweden

AIMS: To analyse whether there is an association between sex and poor self-reported health (SRH) and psychological distress in Kurdish immigrants. METHODS: This cross-sectional study is based on a sample consisting of immigrants, aged 27- 60 years, with self-reported Kurdish ethnicity (n=111, men; n=86, women) in Sweden originating from Iran and Turkey. It is based on data collected in 1996 from the first Swedish National Survey on the living conditions of immigrant groups conducted by Statistics Sweden. The prevalences of reporting poor health, sleeping difficulties, general fatigue and anxiety were estimated by sex. The association between sex and SRH and psychological distress was analysed by an unconditional logistic regression model estimating odds ratios (OR) with 95% confidence intervals. The final model was adjusted for age, marital status, education, housing and employment. Immigrant-specific migration-related variables were used to explore possible reasons for the sex differences. RESULTS: Kurdish men and women had a high prevalence of poor SRH and psychological distress. Age-adjusted odds ratios for anxiety were higher in Kurdish women. Sex differences in anxiety remained even when marital status, education, housing and employment were taken into account. CONCLUSIONS: Kurdish men and women report a high prevalence of poor SRH and indicators of psychological distress. Women had a higher risk for anxiety than men. Negative experiences of pre-migration as well as post-migration experiences, such as economic difficulties, preoccupation with the political situation in the home country, perceived discrimination, and feelings of poor control over one's life, were associated with the outcomes.     

Psychological distress as a risk factor for coronary heart disease in the Whitehall II Study

BACKGROUND: Psychiatric disorder and psychological distress are increasingly recognized as risk factors for coronary heart disease (CHD). Elucidation of the mechanisms of these associations has implications for prevention. This study aims to confirm the association between psychological distress and CHD and examine if it could be explained by other factors such as health behaviours, social isolation and low control at work. METHODS: A prospective occupational cohort study of London-based civil service employees (Whitehall II Study) with baseline data collected from 1985-1988 with a 5-year follow-up. The participants were male and female middle-aged civil servants working in 20 Government Departments; 73% of eligible employees attended baseline screening. Psychological distress measured by the General Health Questionnaire (GHQ) at baseline was used to predict incidence of self-reported CHD and possible and probable electrocardiographic (ECG) abnormalities during follow-up. RESULTS: In men, baseline psychological distress was associated with an increased incidence of overall self-reported CHD (odds ratios [OR] = 1.83, 95% CI : 1.5-2.3) and ECG abnormalities (OR = 1.51, 95% CI : 1.1-2.1), after adjustment for age, employment grade and length of follow-up. In women, baseline psychological distress was also associated with an increased incidence of CHD (OR = 1.60, 95% CI : 1.2-2.1), but not with ECG abnormalities. Adjustment for health behaviours, marital status, social networks and work characteristics reduced the risks for incident CHD by 12% in men and by 10% in women; for ECG abnormalities these adjustments increased the risk in men by 16% and had little effect in women. CONCLUSIONS: The experience of psychological distress confers increased risk of CHD in men that is not explained by health behaviours, social isolation or work characteristics. The increased risk of CHD associated with psychological distress is not consistently demonstrated in women.     

Non-standard employment and mortality in Belgian workers: A census-based investigation

Objectives:Evidence is growing that non-standard employment is associated with adverse health. However, little is known about the relationship between different non-standard employment arrangements and subsequent all-cause and cause-specific mortality. Using population-wide data, the present study investigated this link.Methods:Data was derived from the 2001 Belgian census and a 13-year-long follow-up. The analyses comprised 1 454 033 healthy and disability-free employees aged 30–59 years at baseline. Cox regressions were fitted to analyze the mortality risks of those in non-standard employment forms (temporary agency, seasonal, fixed-term, causal work and employment program) compared to permanent employees.Results:Several groups of workers in non-standard employment arrangements in 2001 exhibited a higher mortality risk relative to permanent employees during the follow-up after adjusting for socio-economic and work-related factors. This was especially the case among men. The relative mortality disadvantage was particularly elevated for male temporary agency workers. External causes of death played an important role in this association.Conclusions:A mortality gradient between the core and outer periphery of the Belgian labor market has been observed. This study also shows that the excess risk of death, previously attributed to non-permanent employment as a whole, hides inequalities between specific forms of non-standard work (eg, temporary agency, seasonal, fixed-term employment).     

Psychological distress after employment transitions: the role of subjective financial position as a mediator

OBJECTIVE: To explore the extent to which the mental health effects of transitions into unemployment, or other forms of non-employment, and vice versa, are mediated by financial changes. METHODS: Longitudinal analysis of the British Household Panel Survey from 1991 to 2000. There were 89,264 person-years of observation from 14,686 individuals aged > or =16 years. Main outcome measure was psychological distress measured by the 12-item General Health Questionnaire. RESULTS: Transitions to unemployment were associated with increased risk of psychological distress for men (adjusted odds ratio (OR) 3.15 (95% confidence interval (CI) 2.50 to 3.98)) and for women (OR 2.60 (95% CI 1.97 to 3.43)). Women who left work to look after the family were also more likely to experience psychological distress (OR 1.72 (95% CI 1.45 to 2.05)). A reduced risk of psychological distress was seen for transitions from unemployment to paid employment for men (OR 0.52 (95% CI 0.41 to 0.68)) and for women (OR 0.68 (95% CI 0.69 to 1.40)). Financial difficulty partially mediated these relationships: men who became unemployed and were worse off financially were more likely to experience psychological distress (OR 4.19 (95% CI 3.20 to 5.50)) than men who were not (OR 1.48 (95% CI 0.95 to 2.33)). Conversely, the beneficial health effect for people who left unemployment and became employed was confined to those who were better off financially (OR 0.34 (0.25 to 0.48) for men). CONCLUSIONS: Changes in employment status have both direct and indirect effects, through changes in financial circumstances, on subsequent psychological distress. The results support the view that the direction of causation runs from employment transitions to financial difficulties and psychological distress.     

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.     

Sickness absence as a risk factor for job termination, unemployment, and disability pension among temporary and permanent employees

Objectives

This study examined sickness absence as a risk factor for job termination, unemployment, and disability pension among temporary and permanent workers.

Methods

Prospective cohort study with data on employment contract and sickness absence in 1996, job termination by 1997, and employment status in 1997 and 2000 for 19 093 temporary and 41 530 permanent public sector employees.

Results

For women aged 40 years or less and for women over 40, a high sickness absence increased the risk of job termination among temporary employees (OR 1.52 (95% CI 1.36 to 1.71) and OR 1.70 (95% CI 1.36 to 2.13) respectively). High absence was not associated with job termination among men in temporary employment. Among permanent employees, high sickness absence predicted job termination among older, but not among younger employees. Temporary employees with high sickness absence were at the highest risk of immediate unemployment and unemployment three years later. Among older permanent employees, high sickness absence was associated with subsequent work disability pension.

Conclusions

A high rate of sickness absenteeism increases the risk of job termination and unemployment among women in temporary public sector jobs. For permanent employees, secure employment provides protection against unemployment even in the case of high sickness absence.     

Labor market trajectories and health: a four-year follow-up study of initially fixed-term employees

With the growth of atypical employment, there is increasing concern about the potential health-damaging effects of unstable employment. This prospective study of Finnish public-sector employees in 1998-2002 examined labor market trajectories and changes in health. At entry, all participants had a fixed-term job contract. Trajectories were measured by exposure to unstable employment during follow-up, destination employment status at the end of follow-up, and the way in which these elements were combined. Nonoptimal self-rated health at baseline was associated with high exposure to unstable employment and unemployment as the destination. After adjustment for health and psychological distress at baseline, a trajectory with stable employment as the destination was associated with a decreased risk of psychological distress at follow-up (odds ratio = 0.68, 95% confidence interval: 0.46, 0.98), whereas a trajectory toward the labor market periphery was related to increased risk of nonoptimal health (odds ratio = 2.54, 95% confidence interval: 1.47, 4.39) when compared with remaining in fixed-term employment. A significant dose-response relation was seen between the measure combining exposure to instability with destination employment status and nonoptimal health. This longitudinal study provides evidence of health-related selection into employment trajectories and suggests that the trajectories themselves carry different health risks.     

Temporary employment and risk of overall and cause-specific mortality

The number of nonpermanent employees is rising, but mortality in this group has received little attention. The authors examined the associations between temporary employment and all-cause and cause-specific mortality. Longitudinal data from 10 towns in Finland related to 26,592 men and 65,759 women, of whom 1,332 died between 1990 and 2001. Cox proportional hazards models adjusted for age, occupational status, salary, and change in occupational title showed that overall mortality was 1.2-1.6 times higher among male and female temporary employees compared with permanent employees. Temporary employment was associated with increased deaths from alcohol-related causes (hazard ratio (HR) = 2.0, 95% confidence interval (CI): 1.4, 2.9 for men; HR = 1.7, 95% CI: 1.1, 2.5 for women) and, for men, smoking-related cancer (HR = 2.8, 95% CI: 1.3, 6.0). Corresponding risks were greater for the unemployed. Moving from temporary to permanent employment was associated with a lower risk of death than remaining continuously in permanent employment (HR = 0.7, 95% CI: 0.5, 0.9 for men and women combined). These findings suggest that the conventional research practice of treating the employed as a single group may attenuate the associations between employment status and mortality.     

The Relationship Between Reproductive Work and Sociodemographic and Psychosocial Factors in Regard to Psychological Distress in Men and Women in Spain

Studies have shown that some sociodemographic factors, such as marital status, employment status or social class, can affect mental health in different ways for each gender. However, up until now, few research projects have tried to ascertain if the role that reproductive work or psychosocial factors play in mental health is different for men and women. The aim of this study is to assess the differences between men and women in terms of how reproductive work, sociodemographic and psychosocial factors are linked to psychological distress in Spain. A cross-sectional study of 29,478 male and female adults using data gathered for the Spanish National Health Survey 2006 was carried out. Psychological distress was measured using the GHQ-12. The independent variables analyzed were: sociodemographic, psychosocial (family functionality and functional social support) and those related to reproductive work (living with or being in charge of different types of people needing care and number of hours devoted to caregiver tasks). Different independent logistic regression models were developed for men and women. In general, with the exception of men who were more prone to psychological distress if they were signed off work for 3 months or more, no major differences were observed regarding the effect of sociodemographic and psychosocial characteristics on psychological distress. With regard to reproductive work, the likelihood of psychological distress doubles in both sexes when the person lives with someone who needs care. In women, a greater number of hours devoted to caring for another person is associated with an increase in distress. Men play a less frequent role in caregiving, but the impact on psychological distress is similar to that in women. Women experienced more psychological distress when they had to live with or be in charge of a disabled person or different types of persons needing care, while men were not affected by this. Major differences have been identified in terms of psychological distress in women and men in several aspects of reproductive work to date unexplored.     

Problematizing gender, work and health: the relationship between gender, occupational grade, working conditions and minor morbidity in full-time bank employees

It is commonly asserted that while women have longer life expectancy than men, they have higher rates of morbidity, particularly for minor and psychological conditions. However, most research on gender and health has taken only limited account of the gendered distribution of social roles. Here we investigate gender differences in morbidity whilst controlling, as far as possible, for one major role, namely participation in paid employment. There is substantial segregation of the labour market by gender; men and women typically work different hours in different occupations which involve varying conditions and differing rewards and costs. Here, we examine men and women working full-time for the same employer. This paper reports on a postal survey of employees (1112 men and 1064 women) of a large British bank. It addresses three main questions: do gender differences in minor morbidity remain if we compare men and women who are employed in similar circumstances (same industry and employer)? What is the relative importance of gender, grade of employment within the organisation, perceived working conditions and orientation to gender roles for minor morbidity? Finally, are these factors related to health differentially for men and women? There were statistically significant gender differences amongst these full-time employees in recent experience of malaise symptoms, but not in physical symptoms or GHQ scores. Controlling for other factors did not reduce the gender differences in malaise scores and produced a weak, but significant, gender difference in GHQ scores. However, gender explained only a small proportion of variance, particularly in comparison with working conditions. Generally similar relationships between experience of work and occupational grade and morbidity were observed for men and women. Throughout the paper, we attempt to problematize gender, recognising that there are similarities between women and men and diversity amongst women and amongst men. However, we conclude that the gendered nature of much of adult life, including paid work, continues to shape the experiences and health of men and women at the end of the twentieth century.