Health effects of unemployment--II. Men and women.

A comparison is made of the life situation and health effects of short term and long term unemployment in 30-50 year old urban men and women. The people under study were employed in an administrative branch of the labour market. Women's situation with reference to the labour market is more complicated than men's situation. In addition to the official, registered unemployment, only among women a substantial hidden unemployment exists. Health is measured by self reported diagnosed chronic diseases, depressive and somatic complaints; health care use i.e. physician consultations, the use of prescribed medicines and being under treatment of a medical specialist. Independent from ordinary confounders like education, age, having a partner etc. in the case of registered official unemployment an adverse health effect of unemployment equally exists for both men and women. The impact of such unemployment shows far more similarities than differences between men and women. Risk factors and paths leading from unemployment to ill-health are also the same among registered unemployed women and men. Contrary to common assumptions, the results indicate that the hidden unemployed form an empirically different category among the unemployed according to health status and to risk factors. The social context of the women's life situation is discussed to explore explanations for these results.     

The impact of unemployment on school leavers’ perception of health. Mediating effect of financial situation and social contacts?

Summary Objectives: The main purpose of this paper is to explore whether unemployment influences adolescents’ subjective perception of health and whether perceived financial stress and social contacts can mediate the effect of employment status on health. We are also interested in the differences in financial situation and social contacts between unemployed secondary school leavers and their employed and studying counterparts. Methods: Data were obtained from 844 adolescents (mean age 19.6) from Slovakia. The effect of unemployment on several health indicators was measured and subsequently controlled for perceived financial strain of respondents and their social contacts. Results: The results showed highest financial strain among unemployed, whereas only small differences in social contacts were found between three groups. Negative influence of unemployment on perceived health of respondents was confirmed. Nevertheless, strong influence was found only on long-term well-being and mental health. Financial situation and social contacts contributed to the prediction of almost all health outcomes, and to some extent mediated the effect of unemployment. Conclusions: Although unemployment was found to have a negative impact on health of adolescents, sufficiency of social contacts and good financial situation seem to decrease this effect and protect the health of unemployed people. Submitted: 22 May 2006; Revised: 16 February 2007; Accepted: 27 February 2007     

Unemployment and health care utilization

OBJECTIVES: This study attempted to determine whether prior use of health services predicts a subsequent risk of unemployment and also to describe the acute effects of exposure to unemployment on the use of health care services. MATERIAL AND METHODS: The 1986 census records were linked with comprehensive health care information for the period 1983-1989 for over 44629 randomly selected residents of Manitoba, Canada. All cause and cause-specific rates of hospital admission and ambulatory physician contacts were compared between 1498 unemployed and 18272 employed persons across 4 consecutive time periods related to the onset of unemployment. RESULTS: The adjusted rates of hospital admission and physician contacts were higher among the unemployed across all 4 periods. When persons with a history of mental health treatment were excluded, health care use in the period prior to the onset of unemployment was equivalent among the employed and unemployed. When a history of mental health treatment was controlled for, all-cause and cause-specific health care use was elevated among the unemployed during the unemployment spell. CONCLUSIONS: Unemployed persons had increased hospitalization rates before their current spell of unemployment. Much of this difference was due to the subgroup with prior mental health treatment. For persons without prior mental health care, hospitalization increased after a period of unemployment.     

Urbanization and mental health in Brazil: social and economic dimensions

While there have been attempts to examine urbanization and the quality of urban life as special risk factors in the generation of mental illness, the issue is controversial and remains largely unresolved. In this article particular consideration is given to the process of contemporary structural transformation in the Brazilian society leading to urbanization. Selected Brazilian studies of mental illness in urban areas are described. Economic displacement, or unemployment, emerges as the most significant risk factor for mental ill-health and is more important than, for example, rural to urban migration. Current studies are then criticized for focusing too much on the search for single risk factors instead of taking the social, structural context into account.     

The Influence of Perceived Health on Labour Participation Among Long Term Unemployed

Backgrounds Few studies have addressed the specific contribution of health in relation to socio-demographic and motivational aspects to re-entering paid employment. The purpose of this study among beneficiaries of unemployment benefits is to evaluate the detrimental effects of poor health and a lack of motivation on the likelihood of getting a job and to develop a decision support model that predicts remaining unemployment after 12 months. Methods A longitudinal cohort study was conducted among people on unemployment benefit (UB) or social insurance benefit (SIB). The time-window of the study was 18 months. Written questionnaires were filled out 3 months post-benefit assessment, 6, 12 and 18 months. Multivariate logistic regression analysis was used to identify the barriers of re-entering paid employment. Subsequently, a predictive model was constructed to estimate the probability for every combination of determinants for a person to remain unemployed in the next 12 months. Results Older age (≥55 years), a poor perceived health, and a lack of willingness to accept a job were the most prominent predictive factors for remaining unemployed after 12 months in both UB and SIB groups. Lower education in the UB group and being married or living together and poor self-reliance in the SIB group were additional risk factors for long-term unemployment. Conclusion Vocational rehabilitation of people on long-term social benefit should address perceived health, socio-demographic, and motivational aspects as key factors that determine prolonged unemployment. A predictive flow chart can be used to detect most vulnerable persons at risk for remaining long-term unemployment.     

Comparison of the general health questionnaire and the Nottingham health profile in a study of unemployed and re-employed men

Two measures of perceived health, the general health questionnaire and the Nottingham health profile were completed by middle and working class men who had been unemployed for between 18 and 24 months, or had been unemployed longer than six months before regaining employment. Clear differences were found between the perceived health status of the unemployed men and those who had become re-employed. Virtually no association was found between social class and scores on the health measures, supporting earlier findings that unemployment leads to equally poor perceived health in middle class and working class males. High correlations were obtained between the 12-item general health questionnaire, the anxiety and the depression scales, with all three measures correlating quite highly with the emotional reactions, sleep and social isolation sections of the Nottingham health profile. However, the Nottingham health profile provided a broader assessment of perceived health, giving additional information on pain and physical mobility problems.     

Service Use of Rural and Urban Medicaid Beneficiaries Suffering From Depression: The Role of Supply

Despite the prevalence and consequence of depression in rural areas, the literature on treating depression in rural areas is relatively scarce and inconclusive. The use of mental health services by rural people suffering from depression and the role that supply may play in explaining these differences are not well understood. Understanding these issues for rural Medicaid beneficiaries is important as Medicaid managed carefor physical and behavioral health care is expanded to rural areas. This study compares the mental health service use of rural and urban Medicaid beneficiaries, ages 18 to 64, in Maine suffering from depression and examines what influence mental health and primary care supply have in explaining observed differences. Two models are used to estimate the use of ambulatory mental health services: (1) a logit likelihood estimate of whether a beneficiary uses any outpatient mental health services for depression; (2) an ordinary least squares regression estimating the number of annualized ambulatory mental health care visits among users. Rural beneficiaries suffering from depression have lower utilization than urban beneficiaries. Rural and urban Aid for Families with Dependent Children (AFDC)--and Supplemental Security Income (SSI)--beneficiaries suffering from depression rely more on mental health than on general health care providers to receive ambulatory mental health care. Rural beneficiaries (AFDC and SSI) rely relatively more on general health care providers than urban beneficiaries. Multivariate analysis suggests that mental health supply and patient-level factors, but not primary care supply, account for utilization differences. This article describes the need to better understand factors limiting participation of primary care providers and to study the role of supply across multiple states.     

Decomposing Area of Residence Differences in Multiple Regression Studies: The Relative Contributions of Independent Variables and Model Coefficients

When rural/urban differences are found in health status or health care use, it is often desirable to identify those factors (such as age, social structure, income, etc.) that influence such differences. To this end, researchers often test rural/urban differences in age, social structure, income, etc., for statistical significance. Also, researchers commonly perform multivariate analyses (such as multiple regressions) to examine rural-urban differences in the influence of various independent variables on the dependent variable of interest. Frequently, researchers discover: (1) statistically significant rural/urban differences in the independent variables (such as age, social structure, income, etc.) and (2) statistically significant rural/urban differences in the effects of these independent variables (i.e., statistically significant rural/urban differences in regression coefficients). The analysis typically stops here, without addressing the relative contributions of (1) and (2) to the rural/urban differences in the dependent variable. This paper argues that the relative contributions of (1) and (2) have important implications for the way policy-makers address rural health problems. This paper presents a method for assessing the relative contributions of differences in the independent variables and differences in regression coefficients to observed differences in the dependent variable, and illustrates the application of the method by analyzing rural/urban differences in the risk of institutionalization.     

城市不在业者卫生服务利用及影响因素分析

目的探索城市不在业者卫生服务利用情况及其影响因素,为有关部门制定政策提供依据。方法从2003年国家卫生服务调查数据库中抽取8412名城市不在业者进行深入分析。结果影响城市不在业者卫生服务利用的主要因素有年龄、文化程度、医疗保障状况。结论需要提高城市不在业者的医疗保障覆盖率。     

Unemployment, health and health services in German-speaking countries

The links between unemployment and health are manifold: Employment may lead to illness: health problems (that may lead to unemployment) often result from unfavourable working conditions of the (previous) employment. Another factor is job insecurity: fear of job loss increases the incidence of disease, and this applies not only to people who are emotionally unstable. Illness may lead to unemployment: in many cases, unemployment is caused by previous health impairments, which, to a considerable extent, also explain the duration of unemployment. Unemployment may lead to illness: there is evidence that unemployment not only reinforces existing physical disease but also acts as a risk factor for new ones. This seems particularly true for problem groups such as the unemployed elderly as well as for infants and children of unemployed people. The relations between unemployment and mental health are strong, mainly in terms of depression and alcoholism. Unemployment may lead to health: short-time work and short-term unemployment may improve health by reducing previous stress, caused by employment or by an overload with social roles. Even in the case of long-term unemployment there are some positive health effects as long as a minimum of social security and alternative social roles are available and useful activities--minor agricultural jobs, illicit work--can be carried out. The links between unemployment, work and society can considerably be loosened by a number of social factors and personal characteristics of the people affected. Existing health services are not in a position to deal with disease stemming from employment or unemployment except through symptomatical and curative therapies. In addition to general medical care, which is guaranteed by the German health insurance system for the unemployed, too, therapeutical measures are especially important in cases of depression and alcoholism. As a rule, the medical profession has no knowledge of the links between health, work and unemployment; such knowledge, however, would facilitate prevention. Individual prevention and rehabilitation measures are of great importance to problem groups suffering from cumulative or indirect unemployment, i.e. to unemployed elderly as well as to children of unemployed parents. Since the unemployed tend to isolate themselves, extramural services are useful. Specific services for the unemployed only are certainly not as helpful as multi-functional social services, such as those being already rendered by some self-help organizations, churches and trade-unions.(ABSTRACT TRUNCATED AT 400 WORDS)     

Health services access and use among older adults in North Carolina: urban vs rural residents.

OBJECTIVES. This study compared health service use and satisfaction with health care among older adults living in urban vs rural counties in North Carolina. METHODS. A stratified random sample of 4162 residents of one urban and four rural counties of North Carolina was surveyed to determine urban/rural variation in inpatient and outpatient health service use, continuity of care and satisfaction with care, and barriers (transportation, cost) to care. RESULTS. Inpatient and outpatient service use did not vary by residence in controlled analyses. Continuity of care was more frequent in rural counties. Transportation was not perceived as a barrier to health care more frequently in rural than in urban counties, but cost was a greater barrier to care among rural elderly people. CONCLUSIONS. In this sample, older persons living in rural counties within reasonable driving distance of urban counties with major medical centers used health services as frequently and were as satisfied with their health care as persons in urban counties. Cost of care, however, was a significant and persistent barrier among rural elderly people, despite Medicare coverage.     

Factors Associated With Health-Related Quality of Life Among an Older Population in a Largely Rural Western Region

CONTEXT: As elderly people become a larger proportion of the rural population, it is important to identify those at risk for poor health. Predictors of health-related quality of life can be useful in designing interventions. PURPOSE: One objective of the present study was to profile the health-related quality of life of community-dwelling, elderly people in a southwestern region of the United States. A related objective was to identify the principal factors associated with health-related quality of life, thereby identifying population subgroups in greatest need of health or social services. METHODS: A telephone survey of approximately 5,000 individuals 65 years and older collected data on need for assistance with activities of daily living, physical and mental health-related quality of life, and worry about health status measures. A modified version of the Behavioral Model was used to more clearly distinguish the different groups at risk for poor health. FINDINGS: Those groups of community-dwelling, elderly people in the poorest health were older than 75 years, had less than a high school education, were retired or unemployed, and had low household income. No differences were found by urban, rural, and frontier residence. CONCLUSIONS: To maintain the physical, social, and psychological health of older people residing in rural and urban areas, social services, medical care, and supportive services are needed, particularly among the most socially and economically disadvantaged.     

Psychosocial work conditions, unemployment and self-reported psychological health: a population-based study

AIM: To investigate the association between psychosocial conditions at work, unemployment and self-reported psychological health. METHODS: A cross-sectional postal questionnaire for the 2000 public health survey in Scania was administered to both working and unemployed people aged 18-64 years. Logistic regression models were used to investigate the association between psychosocial factors at work/unemployment and self-reported psychological health (General Health Questionnaire 12). Psychosocial conditions at work were classified according to the Karasek-Theorell demand-control/decision latitudes into relaxed, active, passive and job strain. The multivariate analyses included age, country of origin, education, economic stress and social participation. RESULTS: A total of 5180 people returned their questionnaire, giving a participation rate of 59%. Fifteen per cent of men and 20% of women reported poor psychological health. Those with high demands and high control (active category), those with high demands and low control (job strain category) and the unemployed had significantly higher odds ratios of poor psychological health compared to those with low demands and high control (relaxed category). Those with low demands and low control (passive category) did not differ significantly from the relaxed category. The associations remained in the multivariate analyses. CONCLUSIONS: The study found that certain psychosocial work factors are associated with higher levels of self-reported psychological ill-health and illustrates the great importance of psychosocial conditions in determining psychological health at the population level. As found elsewhere, being unemployed was an even stronger predictor of psychological ill-health.     

Keeping the unemployed healthy: the effect of means-tested and entitlement benefits in Britain, Germany, and the United States

OBJECTIVES: Although considerable evidence about the health effects of unemployment exists, little is known about the possible protective effects of various social interventions. This study examined the role that means-tested and entitlement programs could have in ameliorating the health impact of unemployment in Britain, Germany, and the United States. METHODS: Logistic regression models were used to analyze panel data from Britain (1991-1993), Germany (1991-1993), and the United States (1985-1987) available in the Household Panel Comparability Project database.The analysis included 8,726 respondents from Britain, 11,086 from Germany, and 11,668 from the United States.The health-dependent variable used was a single measure of perceived health status. RESULTS: Evidence was found of differences in perceived health status between groups of unemployed people characterized by the types of benefits they receive. When socioeconomic characteristics and previous health and employment status are controlled for, means-tested benefits do not seem sufficient to reduce the impact of unemployment on health. CONCLUSIONS: Monitoring the possible health effects of changes in public assistance benefits should be given priority in the research and political agenda.     

Health care utilization among persons who are unemployed or outside the labour force

BACKGROUND: In Sweden, equity in health is a central aim of public health policy. To this end, the health care system is obligated to offer equal access to health care according to need. However, unemployment may hinder the fulfillment of this goal. The aim of the present study was to assess self-reported health care needs and service utilization with respect to employment status. METHODS: A questionnaire was sent to 4000 randomly chosen individuals 20-64 years of age living in different counties in Sweden (response rate 66.2%). Logistic regression analyses were carried out to estimate the influence of employment status, socio-demographic variables and health indicators on the need for and use of health care services. RESULTS: In total, 42.2% (n=35) among the unemployed, 37.4% (n=55) among persons who were on long-term sick leave (LTSD), and 22.3% (n=467) of the employed persons, abstained from consulting a physician despite reporting a perceived need to do so. The results persisted after adjusting for socio-demographic variables, social support and personal finances (unemployed: OR=1.91; LTSD: OR=1.62). The risk of foregoing care remained higher among the unemployed, but not the LTSD-group, after adjusting for long-standing illness (OR=1.94). The unemployed were more likely than the employed to perceive a need to seek care for psychological problems. The risk of abstaining from consulting a physician was related to symptoms of depression. CONCLUSIONS: Lack of employment may be related to unmet care needs, especially among unemployed who are experiencing psychological symptoms. To deal with the needs of the unemployed it may be useful to develop interventions within the health care system that focus more on psychological problems.     

Unemployment, contraceptive behaviour and reproductive outcomes among young Australian women

AIMS: To examine whether unemployment and partnership affects pregnancy, live births and terminations among young Australian women. Unemployment has conventionally been used in epidemiological studies to examine the health effects of loss of opportunity, material resources and satisfaction associated with work. During welfare reform in the 1990s it was argued that unemployment and associated welfare receipt could influence reproductive choice. DESIGN: As part of the Australian Longitudinal Study of Women's Health, information on employment, contraceptive use and pregnancy, live births and terminations was obtained at two time points. Information on partnership, age, parental education, and area economic resources was also obtained. The sample included 9683 women aged 18-23 years in 1996 (time 1) and 2000 (time 2). ANALYSIS: Logistic regressions were conducted to assess the relationship between unemployment and contraceptive use at time 1 and the impact of unemployment at time 1 on pregnancy, live births and terminations at time 2. Analyses accounted for partnership, significant differences in contraception, age, parental education and area economic resources. RESULTS: Despite the absence of differences in overall rates of contraceptive use, rates of pregnancy and live births among young unemployed women were higher than rates among employed women. These differences became non-significant when differences in the need to use contraception and oral contraceptive use were taken into account. There were no differences in terminations due to unemployment overall but partnered unemployed women were more likely to have a termination than other women. CONCLUSIONS: The study did not support the notion that being unemployed provided incentives for single motherhood. However excess terminations suggest that unemployment might provide disincentives to continuing pregnancies among partnered and unemployed women. More detailed examination of contraception and partnership may be key in unraveling inconsistencies in past research.     

Gender differences in the effect of unemployment on psychological distress

In this paper we examine whether unemployment has a differential impact on the expression of psychological distress among men and women. Based on the traditional centrality of the work role to men and the family role to women, we defined several key domains that might affect unemployed men and women differentially: family circumstances, concerns and worries about children and family; coping responses; social support and social integration; and the centrality of the work role. While the study population either were or hoped to be in the labor force and had dependent children, they varied in their marital status and whether they were the custodial parent. Using data collected in Baltimore from those who had been unemployed but had returned to work, those who had remained continuously unemployed for a year, and those who had been continuously employed, we compared the patterns of men's and women's reactions to unemployment. The important differences in psychological symptoms in this population were related to employment status, problems with parenting, financial difficulties, perceived lack of social support, hostility, and feelings about unemployment. By and large, the patterns of these relationships were similar for men and women. These findings suggest that when gender differences in psychological distress are found they may be due to differences in role configurations of men and women rather than intrinsic gender differences.     

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.     

以照顾家人为目的城乡来源流动老年人健康及锻炼行为比较分析

目的 分析比较以照顾家人为目的城乡来源的流动老年人的健康及锻炼行为。 方法 在“2015年全国流动人口卫生计生动态监测调查数据”中获取研究对象3 175名。采用logistic回归分析城乡老年人自评健康及锻炼行为的影响因素。 结果 以照顾家人为目的的流动老年人自评健康和锻炼时长普遍较高,但城乡来源老年人存在差异。二项logistic回归发现,未患高血压/糖尿病、共同居住、本地朋友数量多是城乡老年人自评健康状况好的共性因素,而城市老年人中个人经济独立（OR=1.62, 95%CI: 1.08~2.44）、农村老年人中家庭人均收入更高（OR=1.74, 95%CI : 1.38~2.18）与自评健康状况好相关。有序logistic回归表明,朋友数量多是城乡老年人锻炼时间长的共性因素,而城市老年人经济独立（OR=1.63, 95%CI : 1.08~2.45）和独立居住（OR=1.56, 95%CI : 1.08~2.22）、农村老年人患高血压/糖尿病（OR=1.35, 95%CI : 1.10~1.65）和健康自评好（OR=1.32, 95%CI : 1.11~1.56）与锻炼时间长相关。结论 城乡来源的流动老年人自评健康和锻炼行为及影响因素既有共性也存在差异,需要关注流动老年人群的异质性,同时需要加强社会支持和家庭支持以促进流动老年人健康。     

Health and Well-Being of Childbearing Women in Rural and Urban Contexts

As part of the national focus on women's health issues, it is important to identify those health-related characteristics of rural women that distinguish them from women living in urban settings. The aim of this study was to compare rural and urban childbearing women on socioeconomic characteristics, perceived stress, health-related practices, illness symptoms, parenting confidence, and body weight. One hundred sixty-five midwestern women responded to a health survey sent to them six months after childbirth. Rural women were younger and less educationally and economically advantaged compared to urban women. Before adjusting for these differences, rural women were less self-actualized, more interpersonally isolated, and reported less healthy nutrition than urban women. These differences disappeared when socioeconomic differences were adjusted. Rural and urban mothers did not differ in most other areas, including perceived stress, parenting confidence, and body weight. Compared to national norms, the perceived stress levels of both rural and urban mothers were significantly higher than a probability sample of U.S. women. Findings support the role of socioeconomic factors as contributing to risk of poor health promotion among rural childbearing women.