Healing and/or breaking? The mental health implications of repeated economic insecurity

The little intervention that could: creative aging implies healthy aging among Canadian seniors

OBJECTIVES

Through a process of 'creative ageing', there is increased interest in how active participation in the arts can help promote health and well-being among seniors. However, few studies have quantitatively examined the benefits of a foray into artistic expression, and even fewer employ rigorous identification strategies. Addressing this knowledge gap, we use a series of quantitative techniques (ordinary least squares and quantile regression) to analyze the impact of an arts-based intervention targeting the elderly.

METHODS

Recruited from Saint John, New Brunswick (a city of about 125,000 people in Eastern Canada), 130 seniors were randomly assigned to the programme, with the remaining 122 serving as the control. This intervention consisted of weekly 2-h art sessions (i.e. drawing, painting, collage, clay-work, performance, sculpting, and mixed media), taking place from January 2020 until April 2021.

RESULTS

Relative to the control group, the intervention tended to reduce participant loneliness and depression, and improve their mental health. Outcomes were more evident toward the latter part of the programme, were increasing in attendance, and most efficacious among those with initially low levels of well-being.

CONCLUSION

These findings imply that creative ageing promotes healthy ageing, which is especially noteworthy given COVID-19 likely attenuated our results.

Economic insecurity exposure and cognitive function in late life

OBJECTIVES

This study took the State-owned Enterprises (SOE) reform from 1996 to 2002 in China as a natural experiment to explore the consequences of economic insecurity exposure during early-adulthood and mid-adulthood on cognitive function in later life.

METHODS

Data were obtained from the China Health and Retirement Longitudinal Survey (CHARLS), 2014 and 2015. CHARLS is a nationally representative survey covering 28 provinces in China. A total of 4536 urban dwellers born earlier than 1971 (aged 25 years old and above at the start of the SOE reform in 1996) were included in our analyses. Using province-year-level economic loss from the layoffs, we examined the impact of economic insecurity exposure on the cognitive function score by using a difference-in-differences model with 1996-2002 as the cut-off.

RESULTS

Individuals exposed to economic insecurity have significantly decreased cognitive function, in which a 1% point increase in expected economic loss would decrease the cognitive function score by 0.09 (95% CI: -0.17 to -0.01). Given that the average intensity of expected economic loss was 11.59% and the mean score of cognitive function was 21.26, exposure to the SOE reforms led to an average decrease in the cognitive function score by at least 4.91%.

CONCLUSIONS

Providing cognitive health surveillance and psychological counselling may be important for preventing cognitive decline among those experiencing economic insecurity.

The role of digital transformation in addressing health inequalities in coastal communities: barriers and enablers

Healthcare systems worldwide are striving for the "quadruple aim" of better population health and well-being, improved experience of care, healthcare team well-being (including that of carers) and lower system costs. By shifting the balance of care from reactive to preventive by facilitating the integration of data between patients and clinicians to support prevention, early diagnosis and care at home, many technological solutions exist to support this ambition. Yet few have been mainstreamed in the NHS. This is particularly the case in English coastal areas which, despite having a substantially higher burden of physical and mental health conditions and poorer health outcomes, also experience inequalities with respect to digital maturity. In this paper, we suggest ways in which digital health technologies (DHTs) can support a greater shift towards prevention; discuss barriers to digital transformation in coastal communities; and highlight ways in which central, regional and local bodes can enable transformation. Given a real risk that variations in digital maturity may be exacerbating coastal health inequalities, we call on health and care policy leaders and service managers to understands the potential benefits of a digital future and the risks of failing to address the digital divide.

Does persistent precarious employment affect health outcomes among working age adults? A systematic review and meta-analysis

OBJECTIVE

To evaluate the impact of persistent precarious employment (lasting 12+ months) on the health of working age adults, compared with more stable employment. Persistent precarity reflects a shift towards less secure forms of employment and may be particularly important for health.

METHODS

Nine databases were systematically searched to identify quantitative studies that assessed the relationship between persistent precarious employment and health outcomes. Risk of bias (RoB) was assessed using an adaptation of the Effective Public Health Practice Project tool. Narrative synthesis and random effects meta-analysis were conducted. Certainty of evidence was assessed using the Grades of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Of 12 940 records screened, 50 studies met the inclusion criteria and 29 were included in meta-analyses. RoB was generally high (n=18). The most reported outcome domain was mental health; with evidence also reported relating to general health, physical health,and health behaviours. Of GRADE assessed outcomes, persistent precarious employment was associated with increased risk of poor self-rated health (OR 1.53, 95% CI 1.09 to 2.14, I2=80%) and mental health symptoms (OR 1.44, 95% CI 1.23 to 1.70, I2=65%). The association with all-cause mortality was imprecisely estimated (OR 1.10, 5% CI 0.91 to 1.33, I2=73%). There was very low GRADE certainty across all outcomes.

CONCLUSIONS

Persistent precarious employment is associated with poorer health, particularly for outcomes with short time lags, though associations are small and causality is highly uncertain. Further research using more robust methods is needed but given potential health harms of persistent precarious employment, exploration of precautionary labour regulations and employment policies is warranted.

Trajectories of housing affordability and mental health problems: a population-based cohort study

PURPOSE

With housing costs increasing faster than incomes and a limited supply of social housing options, many households face unaffordable housing. Housing affordability problems may negatively impact mental health; however, longitudinal evidence is limited. This study investigates the association between trajectories of housing affordability problems and mental health.

METHODS

We used data from 30,025 households from Understanding Society, a longitudinal household survey from the UK. Participants spending 30% or more of household income on housing were categorised as facing housing affordability problems. We estimated group-based trajectories of housing affordability problems from 9 waves of data (2009-2019). We used linear regression to calculate the association between the trajectories and mental health problems, as measured by General Health Questionnaire (GHQ) score in Wave 10 (2018-2020).

RESULTS

We found six distinct trajectories of housing affordability problems. Those in the 'stable low' group had a consistently low probability of affordability problems, whilst those in 'high falling' group had a sustained high probability in the earlier waves of the study, subsequently decreasing over time. The adjusted analysis showed that trajectory group membership over the first nine waves of data predicted GHQ score in 2018-2020 (Wave 10). Compared to the 'stable low' group, those in the 'high falling' group had a GHQ score that was 1.06 (95% CI 0.53-1.58) points higher.

CONCLUSION

This study provides evidence that sustained exposure to housing affordability problems is associated with long-term worse mental health, even in the absence of more recent problems.

Self-perceived job insecurity and self-reported health: Differences between native-born and migrant workers based on evidence from the Sixth European Working Conditions Survey

This paper analyses the association between self-perceived job insecurity and self-reported health by comparing two population groups, native-born and migrant workers, in EU15 countries. The econometric analysis employs data from the Sixth European Working Conditions Survey that was released in 2017. The health outcome examined in this study is self-reported health, which is a subjective indicator. Self-perceived job insecurity is an individual’s subjective evaluation of the possibility of future job loss. The association between job insecurity and self-reported health was tested using standard probit models and standard ordered probit models, considering the entire population sample, only native-born workers, only migrant workers. The results show that workers who think that they might lose their jobs have a lower probability of reporting very good and good health than workers who do not worry about losing their jobs, with job insecurity reducing the probability of reporting good health more for migrant workers than for native-born workers.

Are Populists Insecure About Themselves or About Their Country? Political Attitudes and Economic Perceptions

We investigate whether greater economic insecurity increases distrust in government and fosters authoritarian politics. Using the 2016 American National Election Studies dataset, we build on the literature regarding "egotropic" and "sociotropic" economic concerns to distinguish between "micro" insecurity (perceived insecurity regarding the individual's own personal economic well-being), and "macro" insecurity (negative expectations concerning the macro economy). Our results suggest micro insecurity is not significantly correlated with attitudinal differences, but macro-level insecurity is associated with increased levels of political distrust, accompanied by greater authoritarianism. Greater macro-level insecurity is also associated with more negative feelings toward "out-groups" (e.g. Muslims, the LGBTQ+ community, feminists, immigrants) and was a key predictor in reduced affinity for Hillary Clinton and the rise in support for Donald Trump. Results are robust to controls for political affiliation and aggregate macroeconomic indicators, suggesting that rising levels of income inequality and weakening social safety nets increase political polarization and encourage xenophobia, racism, and homophobia.

Averting a public health crisis in England's coastal communities: a call for public health research and policy

Coastal communities have received little attention in the public health literature, perhaps because our mental maps tend to associate socio-economic deprivation and health inequalities with inner cities. Mapping a range of key health indicators at small area level, this paper reveals a distinct core-periphery pattern in disease prevalence, with coastal communities experiencing a high burden of ill health across almost all conditions included in the Quality and Outcomes Framework dataset. Other sources suggest poor outcomes for children and young people living in coastal areas. Low rates of participation in higher education contrast with high rates of hospitalisation for self-harm, alcohol and substance use. Reflecting a shift in the distribution of children living in poverty since the 1990s, this may be an early indicator of a future public health crisis in these communities. Exploring reasons for the health challenges facing the periphery, this perspective piece calls for more public health research that can accommodate the complex and interlinked problems facing coastal communities and a more concerted effort to align public health with economic, education, local government and transport policies at the national level.

The intergenerational effects of socioeconomic inequality on unhealthy bodyweight

We study the effects of inherited socioeconomic characteristics on markers of unhealthy bodyweight. Taking Australian microdata from 2007 to 2013, we show that approximately 4% of the variation in outcomes is determined by factors beyond an individual's control, such as their race, gender, and social class. Paternal socioeconomic status is the primary explanatory factor, with those born to more affluent fathers slightly less likely to be overweight in adulthood. Decompositions reveal that only 20%-25% of this effect is attributable to advantaged families exhibiting better health behaviors, which implies that unobserved factors also play an important role. Since diseases associated with unhealthy weight place a major strain on public healthcare systems, our results have implications for the provision of treatment when resources are constrained.

Changes in Job Security and Mental Health: An Analysis of 14 Annual Waves of an Australian Working-Population Panel Survey

We examined whether job security improvements were associated with improvements in mental health in a large, nationally representative panel study in Australia. We used both within-person fixed effects (FE) and random effects (RE) regression to analyze data from 14 annual waves covering the calendar period of 2002-2015 (19,169 persons; 106,942 observations). Mental Health Inventory-5 scores were modeled in relation to self-reported job security (categorical, quintiles), adjusting for age, year, education, and job change in the past year. Both FE and RE models showed stepwise improvements in Mental Health Inventory-5 scores with improving job security, with stronger exposure-outcome relationships in the RE models and for men compared with women. The RE coefficients for improvements in job security in men were 2.06 (95% confidence interval (CI): 1.67, 2.46) for 1 quintile, steadily increasing for 2- (3.94 (95% CI: 3.54, 4.34)), 3- (5.82 (95% CI: 5.40, 6.24)), and 4-quintile (7.18 (95% CI: 6.71, 7.64)) improvements. The FE model for men produced slightly smaller coefficients, reaching a maximum of 5.55 (95% CI: 5.06, 6.05). This analysis, with improved causal inference over previous observational research, showed that improving job security is strongly associated with decreasing depression and anxiety symptoms. Policy and practice intervention to improve job security could benefit population mental health.

All-cause mortality and the time-varying effects of psychosocial work stressors: A retrospective cohort study using the HILDA survey

The effects of poor-quality work (high job demands, low job control, job insecurity, and effort-reward imbalance) are harmful to health but it isn't clear whether exposure to these psychosocial work stressors over time translates into increased risk of mortality.

OBJECTIVE

We investigated the effect of time-varying psychosocial work stressors on mortality using data from a longitudinal cohort of working Australians by examining association between job control, job demands, job insecurity, unfair pay overtime and all-cause mortality. We examined whether gender modified these relationships.

METHODS

Over 20,000 participants from the Household Income and Labour Dynamics in Australia survey with self-reported repeated exposure measures were followed for 15 years. Survival analysis models with baseline hazard specified by the Weibull distribution were used to examine the association between psychosocial work stressors over time and mortality.

RESULTS

Low job control (HR=1.39; 95% CI: 1.06-1.83) and job insecurity (1.36; 1.06-1.74) were associated with increased risk of mortality. High job demands (1.01; 0.75-1.34) and effort-reward unfairness (1.20; 0.90-1.59) were not associated with mortality. The effect of job insecurity was attenuated (1.20; 0.93-1.54) after controlling for sociodemographic and health risk factors. Male participants exposed to low job control and job insecurity had an 81% and 39% increase risk of mortality, respectively.

CONCLUSIONS

Long-term exposure to low job control and low job security is associated with increased risk of all-cause mortality. Effects were largely restricted to males and persisted after adjustments for sociodemographic and health characteristics. The lack of effects observed for females may have been due to the small number of deaths in females. Awareness of implications of the adverse effects of psychosocial work stressors on health and mortality in workplaces, and interventions to improve job control and job security could contribute to better health and wellbeing, reducing the effect of psychosocial work stressors on mortality.

Perceived Job Insecurity and Anxiety. A Multilevel Analysis on Male and Female Workers in European Countries

A growing body of evidence has been produced on the adverse effects of job insecurity on health and well-being. Current research in the field conveys a few concerns, some of which are related to gender and cross-national differences in the experience of job insecurity. In order to fill these gaps this study draws on three waves (2005, 2010, 2015) of the European Working Conditions Survey and investigates, using mixed-effects logistic regression: (i) the relationship between anxiety and perceived job insecurity; and whether such relationship: (ii) is different for men and women; (iii) and varies across European countries. Results indicate that male and female workers perceiving the risk of involuntary job loss have similar odds of reporting anxiety. Furthermore, the variance in slopes across countries, relative to the general trend, is significant but modest, too, thus suggesting that the relationship under investigation is fairly similar across European countries. Implications of the findings for future research and practice are discussed.

Psychosocial work stressors and risk of mortality in Australia: analysis of data from the Household, Income and Labour Dynamics in Australia survey

Objective

To examine the association between exposures to psychosocial work stressors and mortality in a nationally representative Australian working population sample.

Methods

18 000 participants from the Household, Income and Labour Dynamics in Australia survey with self-reported job demands, job control, job security and fair pay psychosocial work stressors exposures at baseline were followed for up to 15 waves. Cox proportional hazards regression models were used to examine the association between psychosocial work stressors and mortality. Models were serially adjusted for each subgroup of demographic, socioeconomic, health and behavioural risk factors.

Results

Low job control was associated with a 39% increase in the risk of all-cause mortality (HR 1.39; 95% CI 1.04 to 1.85), controlling for demographic, socioeconomic, health and behavioural factors. A decreased risk of mortality was observed for workers with exposure to high job demands (HR 0.76; 95% CI 0.60 to 0.96, adjusted for gender and calendar), but the risk was attenuated after serially adjusting for socioeconomic status, health (HR=0.84; 95% CI 0.65 to 1.08) and behavioural (HR=0.79; 95% CI 0.60 to 1.04) factors. There did not appear to be an association between exposure to job insecurity (HR 1.03; 95% CI 0.79 to 1.33) and mortality, or unfair pay and mortality (HR 1.04; 95% CI 0.80 to 1.34).

Conclusions

Low job control may be associated with an increased risk of all-cause mortality. Policy and practice interventions that reduce the adverse impact of low job control in stressful work environments could be considered to improve health and decrease risk of mortality.

Can positive income anticipations reverse the mental health impacts of negative income anxieties?

Prospect theory suggests losses are more influential than equivalent sized gains in individual level decision-making. Extending this literature, we use longitudinal National Population Health Survey data (2000-01 to 2010-11) to investigate whether experienced psychological distress impacts of greater economic insecurity for working age Canadians can be fully reversed by equal sized increases in security. Economic insecurity (security) is defined as the probability of an annual income decrease (increase) of 25 percent or more. Our identification strategy employs fixed effects estimation and a set of instruments to control for unobserved heterogeneity and reverse causality. Results suggest that an initial one standard deviation increase in economic insecurity predicts a rise in psychological distress of about 0.57 standard deviations for males and 0.54 standard deviations for females. Good economic news of a similar magnitude has considerably less impact, reducing psychological distress by 0.16 and 0.35 standard deviations for males and females respectively.

Economic insecurity: A socioeconomic determinant of mental health

Economic insecurity is an emerging topic that is increasingly relevant to the labour markets of developed economies. This paper uses data from the British Household Panel Survey to assess the causal effect of various aspects of economic insecurity on mental health in the UK. The results support the idea that economic insecurity is an emerging socioeconomic determinant of mental health, although the size of the effect varies across measures of insecurity. In particular, perceived future risks are more damaging to mental health than realised volatility, insecurity is more damaging for men, and the negative effect of insecurity is constant throughout the income distribution. Importantly, these changes in mental health are experienced without future unemployment necessarily occurring.