Poor psychosocial job conditions increase sickness absence: evidence from the PATH Through Life Mid-Aged Cohort

OBJECTIVES

Evidence is mounting that poor psychosocial job conditions increase sickness absence, but there is a need for further rigorous prospective research to isolate the influence of psychosocial job quality from other measured and unmeasured confounders. This study used four waves of prospective longitudinal data (spanning 12 years) to investigate the extent to which increases in poor psychosocial job quality are associated with greater relative risk of day of sickness absence.

DESIGN

Prospective cohort study.

SETTING

Data were from the Australian PATH Through Life cohort study. The analyses adopted hybrid-regression estimations that isolated the effect of within-person change in psychosocial job quality on sickness absence over time.

PARTICIPANTS

Participants were from a midlife cohort aged 40-44 at baseline (7644 observations from 2221 participants).

PRIMARY OUTCOME MEASURE

Days sickness absence in the past 4 weeks.

RESULTS

The results show that after adjusting for a wide range of factors as well as unmeasured between-person differences in job quality, each additional psychosocial job adversity was associated with a 12% increase in the number of days of sickness absence (relative risk ratio: 1.12, 95% CI 1.03 to 1.21). Increases in psychosocial job adversity were also related to greater functional impairment (relative risk ratio: 1.17 (1.05 to 1.30)).

CONCLUSION

The results of this study strengthen existing research highlighting the importance of addressing poor psychosocial job quality as a risk factor for sickness absence.

"Is Life Worth Living?": The Role of Masculinity in the Way Men Aged Over 80 Talk About Living, Dying, and Suicide

Men aged 85 years and over have the highest rate of suicide of any age or gender group in Australia. However, little is known about their trajectory toward suicide. The objective of this study was to understand the role of masculine norms and other life factors in the suicidality of older men. Thirty-three men aged 80 years or more took part in a semistructured focus group or interview, and/or completed a survey. Participants were asked about the issues facing older men, well-being and aging, physical health challenges, social support, mental health and help-seeking, and suicide and suicide prevention. Five themes emerged: "finding out we're not invincible," "active and tough," "strong silent types," "decision makers," and "right to die." Participants spoke about masculine norms that had influenced their lives as providers and decision makers, and now influenced how they coped with aging and their journey toward death. For some participants, suicide was seen to be a rational alternative to dependence in their final years. Suicide prevention should adopt a gendered approach and be cognizant of the influence of gender roles and masculinity in older men's lives. Further research and prevention efforts should be mindful of the impact of masculine norms of self-reliance and control on an older man's decision to end his life. Suicide prevention efforts should work to reduce stigma around the challenges of aging, maximize opportunities for control, facilitate social connection, and improve residential aged care.

1198The gendered associations between poverty, marital status, and mental health in older Australians

Background

Compared to men, older women have poorer mental health and are more vulnerable to poverty. Few studies have examined how gender, marital status and poverty are inter-related and are associated with mental health among this group.

Methods

Drawing on 17 waves of the Housing Income and Labour Dynamics in Australia survey, fixed-effects regression analysis was utilised to examine associations between: (1) relative poverty (<50% median household income) and mental health (MHI-5); (2) marital status and poverty, among Australians aged 65+years. Effect measure modification (EMM) of the association between relative poverty and mental health by marital status was also assessed.

Results

Relative poverty was associated with poorer mental health among women (−0.62, 95%CI−1.06,−0.18), but not men. Being divorced/separated was associated with increased odds of relative poverty for women (OR 3.93, 95%CI 2.54,6.06) but not men, and widowhood was associated with relative poverty in women (OR 4.23, 95%CI 3.37,5.29), and men (OR 2.22, 95%CI 1.62,3.05). There was no evidence of EMM of the relationship between relative poverty and mental health by marital status for either gender.

Conclusions

This study provides evidence that relative poverty is a major determinant of mental health in older Australian women. Addressing gender inequities in lifetime savings, as well as in division of acquired wealth post marital loss, may mitigate these disparities.

Key messages

A gendered double burden of mental health issues and poverty exists for older Australian women, requiring urgent policy attention.

Health Literacy in Male-Dominated Occupations

Low levels of health literacy are associated with poorer health outcomes. Both individual- and social-level factors have been identified as predictors of low health literacy, and men are known to have lower health literacy than women. Previous research has reported that men working in male-dominated occupations are at higher risk of accidents, injury, and suicide than other population groups, yet no study to date has examined the effect of gendered occupational contexts on men’s health literacy. The current article examined the association between occupational gender ratio and health literacy among Australian males. The Australian Longitudinal Study on Male Health (Ten to Men) was used to examine associations between occupational gender ratio (measured in Wave 1) and health literacy (measured in Wave 2) across three subscales of the Health Literacy Questionnaire. Multivariable linear regression analyses were used and showed that the more male dominated an occupational group became, the lower the scores of health literacy were. Results for the different subscales of health literacy for the most male-dominated occupational group, compared to the non-male-dominated group were: ability to find good health information, (Coef. −0.80, 95% CI [−1.05, −0.54], p < .001); ability to actively engage with health-care providers, (Coef. −0.35, 95% CI [−0.62, −0.07], p = .013); and feeling understood and supported by health-care providers, (Coef. −0.48, 95% CI [−0.71, −0.26],p = < .001). The results suggest the need for workplace interventions to address occupation-level factors as an influence on health literacy among Australian men, particularly among the most male-dominated occupational groups.

Overt acts of perceived discrimination reported by British working-age adults with and without disability

BACKGROUND

Exposure to discrimination can have a negative impact on health. There is little robust evidence on the prevalence of exposure of people with disabilities to discrimination, the sources and nature of discrimination they face, and the personal and contextual factors associated with increased risk of exposure.

METHODS

Secondary analysis of de-identified cross-sectional data from the three waves of the UK's 'Life Opportunities Survey'.

RESULTS

In the UK (i) adults with disabilities were over three times more likely than their peers to be exposed to discrimination, (ii) the two most common sources of discrimination were strangers in the street and health staff and (iii) discrimination was more likely to be reported by participants who were younger, more highly educated, who were unemployed or economically inactive, who reported financial stress or material hardship and who had impairments associated with hearing, memory/speaking, dexterity, behavioural/mental health, intellectual/learning difficulties and breathing.

CONCLUSIONS

Discrimination faced by people with disabilities is an under-recognised public health problem that is likely to contribute to disability-based health inequities. Public health policy, research and practice needs to concentrate efforts on developing programs that reduce discrimination experienced by people with disabilities.

Do psychosocial job stressors differentially affect the sleep quality of men and women? A study using the HILDA Survey

The aim of this study was to investigate whether gender was an effect modifier of the relationship between three psychosocial job stressors and sleep quality, in a representative sample of 7280 employed Australians. We conducted linear regressions and effect measure modification analyses. Low job control, high job demands and low job security were associated with poorer sleep quality. There was evidence of effect modification of the relationship between job security and sleep quality by gender on the additive scale, indicating that the combined effect of being male and having low job security is greater than the summed interactive effect.

The impact of transitions from employment to retirement on suicidal behaviour among older aged Australians

PURPOSE

Transition from employment to retirement may be detrimental to mental health, and associated with suicidal behaviour. This study investigated the association between employment and retirement status and suicidal behaviour among older aged Australians.

METHODS

This study was based on the '45 and Up Study', a large prospective cohort study of participants from New South Wales (Australia) aged 45 years and older (N = 267,153), followed up over the period 2006-2018. The risk of attempted suicide and suicide was compared between categories of employment and retirement status in a series of recurrent event survival analysis models adjusting for identified time variant and invariant confounders.

RESULTS

Compared to those who were employed, the risk of attempted suicide was higher among those who were not in the labour force and not retired (predominantly those who were sick or disabled, or carers) (HR = 1.97-95% CI 1.49-2.62), those who retired involuntarily (HR = 1.35-95% CI 1.03-1.77), and to a lesser extent those unemployed (HR = 1.31-95% CI 0.89-1.92). Risk of attempted suicide among those who retired voluntarily was similar to those who remained employed (HR = 1.09-95% CI 0.82-1.45). A similar pattern was evident for suicide, with a higher risk of suicide among those who were not in the labour force or retired, and those who retired involuntarily, compared to those who remained employed; however, these differences were not statistically significant.

CONCLUSION

Transition from employment to retirement may be an important precipitating factor for suicidal behaviour, affected by current and previous mental health status. Services and programs facilitating continued or re-employment in older age, and adjustment to the transition from employment to retirement may prevent suicidal behaviour.

Gender Equality and Health in High-Income Countries: A Systematic Review of Within-Country Indicators of Gender Equality in Relation to Health Outcomes

Background: Gender equality is recognized as an important political, social, and economic goal in many countries around the world. At a country level, there is evidence that gender equality may have an important influence on health. Historically gender equality has mainly been measured to allow for between-country, rather than within-country comparisons; and the association between gender equality and health outcomes within countries has been under-researched. This article thus aimed to systematically review within-country indicators of gender equality in public health studies and assess the extent to which these are related to health outcomes. Materials and Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach with two independent reviewers. Results: Data from the eight included studies revealed that there was heterogeneity in the way gender equality has been measured as a multidimensional construct. Associations between gender equality and a number of different health outcomes were apparent, including mortality, mental health, morbidity, alcohol consumption, and intimate partner violence, with gender equality mostly associated with better health outcomes. Conclusions: Further investigation into the effects of gender equality on health outcomes, including a clear conceptualization of terms, is critical for the development of policies and programs regarding gender equality.

Gendered experiences of unemployment, suicide and self-harm: a population-level record linkage study

BACKGROUND

Unemployment and being not in the labour force (NILF) are risk factors for suicide, but their association with self-harm is unclear, and there is continuing debate about the role of confounding by prior mental health conditions. We examine associations between employment status and self-harm and suicide in a prospective cohort, taking into account prior mental-health-related factors.

METHODS

We used linked data from the New Zealand Integrated Data Infrastructure. The outcomes were chosen to be hospital presentation for self-harm and death by suicide. The exposure was employment status, defined as employed, unemployed, or NILF, measured at the 2013 Census. Confounders included demographic factors and mental health history (use of antidepressant medication, use of mental health services, and prior self-harm). Logistic regression was used to model effects. Analyses were stratified by gender.

RESULTS

For males, unemployment was associated with an increased risk of suicide [odds ratio (OR): 1.48, 95% confidence interval (CI): 1.20-1.84] and self-harm (OR: 1.55, 95% CI: 1.45-1.68) after full adjustment for confounders. NILF was associated with an increased risk of self-harm (OR: 1.43, 95% CI: 1.32-1.55), but less of an association was seen with suicide (OR: 1.19, 95% CI: 0.94-1.49). For females, unemployment was associated with an increased risk of suicide (OR: 1.30, 95% CI: 0.93-1.80) and of self-harm (OR: 1.52, 95% CI: 1.43-1.62), and NILF was associated with a similar increase in risk for suicide (OR: 1.31, 95% CI: 0.98-1.75) and self-harm (OR: 1.32, 95% CI: 1.26-1.40).

DISCUSSION

Exclusion from employment is associated with a considerably heightened risk of suicide and self-harm for both men and women, even among those without prior mental health problems.

Educational and Employment Outcomes among Young Australians with a History of Depressive Symptoms: A Prospective Cohort Study

The aim of this study was to investigate whether depressive symptoms reported during adolescence are associated with subsequent educational and employment outcomes, including whether experiences of depressive symptoms in adolescence are associated with higher exposures to adverse psychosocial job stressors among those who were employed in emerging adulthood. We used data from the Victorian arm of the International Youth Development Study (IYDS). Multiple logistic regression analyses were used to model the association of depressive symptoms reported in 2002 (wave one) and/or 2003 (wave two) and self-reported completion of compulsory secondary schooling, employment status, and exposure to a number of psychosocial job stressors roughly a decade later (i.e., at wave three in 2014). In fully adjusted models, reporting high depressive symptoms at waves one or two (odds ratio (OR) 0.71, 95% confidence interval (CI) 0.55 to 0.92), as well as at both waves (OR 0.55, 95% CI 0.41 to 0.75) were associated with a reduced likelihood of completing secondary schooling by wave three. High depressive symptoms reported at multiple waves were also associated with a reduced likelihood of employment (OR 0.49, 95% CI 0.36 to 0.66). Amongst those employed at wave three (n = 2091; 72.5%), adolescent depressive symptoms were associated only with workplace incivility. Psychosocial job stressor exposures should be considered in the design and selection of jobs for young workers with a history of depressive symptoms in order to increase employment participation and sustainability for young people experiencing symptoms of depression.

Physicians' attitudes to disability pension - impact of diagnosis: an experimental study

Background

The purpose of this study is to increase understanding of physicians’ attitudes towards disability pension applicants, and the impact of diagnosis. We hypothesize that physicians are more likely to think that patients with physical illnesses should get a disability pension than those with mental illness or alcohol dependence. Disability pension is an important source of income for those unable to work because of a disability and type of diagnosis should not impact accessing these benefits.

Methods

We conducted an experiment with a 2 by 3 factorial structure in Sweden. Each physician was randomly assigned one of six patient vignettes, with the same background description but with a different diagnosis. Each vignette had a diagnosis of either depression, alcohol dependence or low back pain, and was about a man or a woman. Logistic regression was used to examine the odds of a physician reporting that a patient should get a disability pension. Effects are reported in terms of odds ratios (ORs).

Results

1414 Swedish registered physicians in psychiatry or general practice (24% response rate) completed the survey. Physicians assigned the alcohol dependent vignette had OR 0.45 (95% CI: 0.34 to 0.60) for perceiving that a patient should get a disability pension compared to physicians assigned the low back pain vignette. Physicians assigned the depression vignette had OR 1.89 (95% CI: 1.42 to 2.50) for perceiving that a patient should get a disability pension compared to physicians assigned the low back pain vignette.

Conclusion

The patient diagnosis was associated with the physicians’ response regarding if the patient should get a disability pension. A physician’s perception is likely to impact a patient’s access to disability pension.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-020-06043-2.

How do employment conditions and psychosocial workplace exposures impact the mental health of young workers? A systematic review

PURPOSE

To assess the quality of the research about how employment conditions and psychosocial workplace exposures impact the mental health of young workers, and to summarize the available evidence.

METHODS

We undertook a systematic search of three databases using a tiered search strategy. Studies were included if they: (a) assessed employment conditions such as working hours, precarious employment, contract type, insecurity, and flexible work, or psychosocial workplace exposures such as violence, harassment and bullying, social support, job demand and control, effort-reward imbalance, and organizational justice; (b) included a validated mental health measure; and (c) presented results specific to young people aged ≤ 30 years or were stratified by age group to provide an estimate for young people aged ≤ 30 years. The quality of included studies was assessed using the Risk of Bias in Non-randomized Studies of Exposures (ROBINS-E) tool.

RESULTS

Nine studies were included in the review. Four were related to employment conditions, capturing contract type and working hours. Five studies captured concepts relevant to psychosocial workplace exposures including workplace sexual harassment, psychosocial job quality, work stressors, and job control. The quality of the included studies was generally low, with six of the nine at serious risk of bias. Three studies at moderate risk of bias were included in the qualitative synthesis, and results of these showed contemporaneous exposure to sexual harassment and poor psychosocial job quality was associated with poorer mental health outcomes among young workers. Longitudinal evidence showed that exposure to low job control was associated with incident depression diagnosis among young workers.

CONCLUSIONS

The findings of this review illustrate that even better studies are at moderate risk of bias. Addressing issues related to confounding, selection of participants, measurement of exposures and outcomes, and missing data will improve the quality of future research in this area and lead to a clearer understanding of how employment conditions and psychosocial workplace exposures impact the mental health of young people. Generating high-quality evidence is particularly critical given the disproportionate impact of COVID-19 on young people's employment. In preparing for a post-pandemic world where poor-quality employment conditions and exposure to psychosocial workplace exposures may become more prevalent, rigorous research must exist to inform policy to protect the mental health of young workers.

Psychosocial Work Factors of the Job Strain Model and All-Cause Mortality: The STRESSJEM Prospective Cohort Study

OBJECTIVE

The objectives were to examine the prospective associations between psychosocial work factors of the job strain model and all-cause mortality in a national representative cohort of French employees using various measures of time-varying exposure.

METHODS

The study was based on a sample of 798,547 men and 697,785 women for which data on job history from 1976 to 2002 were linked to mortality data from the national death registry. Psychosocial work factors from the validated job strain model questionnaire were imputed using a job-exposure matrix. Three time-varying measures of exposure were explored: current, cumulative, and recency-weighted cumulative exposure. Cox proportional hazards models were performed to study the associations between psychosocial work factors and mortality.

RESULTS

Within the 1976-2002 period, 88,521 deaths occurred among men and 28,921 among women. Low decision latitude, low social support, job strain, isostrain, high strain, and passive job were found to be risk factors for mortality. The model using current exposure was the best relative-quality model. The associations of current exposure to job strain and mortality were found to have hazard ratios of 1.30 (95% confidence interval [CI] = 1.24-1.36) among men and 1.15 (95% CI = 1.06-1.25) among women. The population fractions of mortality attributable to job strain were 5.64% (95% CI = 4.56%-6.71%) among men and 4.13% (95% CI = 1.69%-6.71%) among women.

CONCLUSIONS

This study supports the role of the psychosocial work factors of the job strain model on all-cause mortality. Preventive intervention to improve the psychosocial work environment may help to prevent mortality in working populations.

Socioeconomic Disadvantage, Mental Health and Substance Use in Young Men in Emerging Adulthood

Emerging adulthood is a neglected phase of the life course in health research. Health problems and risk behaviors at this time of life can have long-term consequences for health. The 2016 Lancet Commission on Adolescent Health and Wellbeing reported that the influence of socioeconomic factors was under-researched among adolescents and young adults. Moreover, the influence of socioeconomic factors on health has been little researched specifically in emerging adult men. We aimed to investigate associations between socioeconomic disadvantage and mental health, suicidal behavior, and substance use in young adult Australian men. Logistic regression was used to examine the association between Year 12 (high school) completion and area disadvantage on mental health, suicidal behavior, and substance use in 2,281 young men age 18-25 participating in the Australian Longitudinal Study on Male Health (Ten to Men). In unadjusted analysis both Year 12 non-completion and area disadvantage were associated with multiple adverse outcomes. In adjusted analysis Year 12 non-completion, but not area disadvantage, was associated with poorer mental health, increased odds of suicidal behavior, and substance use. Retaining young men in high school and developing health-promotion strategies targeted at those who do exit education early could both improve young men's mental health and reduce suicidal behavior and substance use in emerging adulthood.

Does disability modify the relationship between labour force status and psychological distress among young people?

OBJECTIVE

To examine the association between labour force status, including young people who were unemployed and having problems looking for work, and psychological distress one year later. We then assessed whether this association is modified by disability status.

METHODS

We used three waves of cohort data from the Longitudinal Surveys of Australian Youth. We fitted logistic regression models to account for confounders of the relationship between labour force status (employed, not in the labour force, unemployed and having problems looking for work) at age 21 years and psychological distress at age 22 years. We then estimated whether this association was modified by disability status at age 21 years.

RESULTS

Being unemployed and having problems looking for work at age 21 years was associated with odds of psychological distress that were 2.48 (95% CI 1.95 to 3.14) times higher than employment. There was little evidence for additive effect measure modification of this association by disability status (2.52, 95% CI -1.21 to 6.25).

CONCLUSIONS

Young people who were unemployed and having problems looking for work had increased odds of poor mental health. Interventions should focus on addressing the difficulties young people report when looking for work, with a particular focus on supporting those young people facing additional barriers to employment such as young people with disabilities.

Breadwinners and Losers: Does the Mental Health of Mothers, Fathers, and Children Vary by Household Employment Arrangements? Evidence From 7 Waves of Data From the Longitudinal Study of Australian Children

In Australia, as in many industrialized countries, the past 50 years have been marked by increasing female labor-force participation. It is popularly speculated that this might impose a mental-health burden on women and their children. This analysis aimed to examine the associations between household labor-force participation (household employment configuration) and the mental health of parents and children. Seven waves of data from the Longitudinal Study of Australian Children were used, comprising 2004-2016, with children aged 4-17 years). Mental health outcome measures were the Strengths and Difficulties Questionnaire (children/adolescents) and 6-item Kessler Psychological Distress Scale (parents). A 5-category measure of household employment configuration was derived from parental reports: both parents full-time, male-breadwinner, female-breadwinner, shared-part-time employment (both part-time) and father full-time/mother part-time (1.5-earner). Fixed-effects regression models were used to compare within-person effects, controlling for time-varying confounders. For men, the male-breadwinner configuration was associated with poorer mental health compared with the 1.5-earner configuration (β = 0.21, 95% confidence interval: 0.05, 0.36). No evidence of association was observed for either women or children. This counters prevailing social attitudes, suggesting that neither children nor women are adversely affected by household employment configuration, nor are they disadvantaged by the extent of this labor-force participation. Men's mental health appears to be poorer when they are the sole household breadwinner.

Associations between gender equality and health: a systematic review

This systematic review sought to evaluate the impact of gender equality on the health of both women and men in high-income countries. A range of health outcomes arose across the 48 studies included. Gender equality was measured in various ways, including employment characteristics, political representation, access to services, and with standard indicators (such as the Global Gender Gap Index and the Gender Empowerment Measure). The effects of gender equality varied depending on the health outcome examined, and the context in which gender equality was examined (i.e. employment or domestic domain). Overall, evidence suggests that greater gender equality has a mostly positive effect on the health of males and females. We found utility in the convergence model, which postulates that gender equality will be associated with a convergence in the health outcomes of men and women, but unless there is encouragement and support for men to assume more non-traditional roles, further health gains will be stymied.

The effect of gender on mental health service use: an examination of mediation through material, social and health-related pathways

PURPOSE

We aimed to understand how much of the gender difference in mental health service use could be due to the joint mediation of employment, behavioural and material factors, social support and mental health need.

METHODS

We used data from employed individuals aged 18-65 years who participated in the 2015-2017 waves of the Household, Income and Labour Dynamics in Australia survey. The exposure (male, female) and confounders were measured in 2015, mediators in 2016 and the outcome-whether a person had seen a mental health professional in the previous year-was measured in 2017. We estimated natural mediation effects using weighted counterfactual predictions from a logistic regression model.

RESULTS

Men were less likely to see a mental health care provider than women. The total causal effect on the risk difference scale was  - 0.045 (95% CI  - 0.056,  - 0,034). The counterfactual of men taking the mediator values of women explained 28% (95% CI 1.7%, 54%) of the total effect, with the natural direct effect estimated to represent an absolute risk difference of  - 0.033 (95% CI  - 0.048,  - 0.018) and the natural indirect effect  - 0.012 (95% CI  - 0.022,  - 0.0027).

CONCLUSION

Gendered differences in the use of mental health services could be reduced by addressing inequalities in health, employment, material and behavioural factors, and social support.

The Influence of Masculine Norms and Mental Health on Health Literacy Among Men: Evidence From the Ten to Men Study

BACKGROUND

Adherence to masculine norms, such as self-reliance, has been thought to predict lower health literacy. Additionally, males with poor mental health may have low health literacy. Using two waves of the Ten to Men cohort, the current study examined whether masculinity and depressive symptomology explained three aspects of health literacy among men.

METHODS

Three subscales of the Health Literacy Questionnaire were used as the outcomes: Ability to find good health information; Ability to actively engage with healthcare providers, and Feeling understood and supported by healthcare providers. Exposures were masculine norms, measured by the Conformity to Masculine Norms Inventory (CMNI-22), and depressive symptoms, measured by the Patient Health Questionnaire (PHQ). We controlled for confounders of the relationship between exposure and outcome. Ordinary least squares regression was used to assess the CMNI and depressive symptoms (measured in Wave 1) on health literacy (measured in Wave 2).

RESULTS

Across all three health literacy scales, increased global conformity to masculine norms was associated with a decrease in health literacy. Moderate-to-severe depressive symptoms were likewise associated with a decrease in health literacy on all three scales, with the effects particularly strong for "Ability to engage with healthcare providers" (coef. -1.54, 95% CI [-1.84, -1.24], p value < .001).

CONCLUSIONS

The results of this article highlight that both conformity to masculine norms and depressive symptoms may be predictors of health literacy among men. The results of this study suggest the need for health literacy media campaigns that address the complexities of gendered help-seeking behaviors.

TRIAL REGISTRATION

Not applicable.

Gendered working environments as a determinant of mental health inequalities: a systematic review of 27 studies

BACKGROUND

'Gendered working environments' describes the ways in which (1) differential selection into work, (2) variations in employment arrangements and working hours, (3) differences in psychosocial exposures and (4) differential selection out of work may produce varied mental health outcomes for men and women. The aim of this study was to conduct a systematic review to understand gender differences in mental health outcomes in relation to the components of gendered working environments.

METHODS

The review followed a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) search approach and focused on studies published in 2008-2018. The protocol for the review was prospectively registered with PROSPERO (CRD42019124066).

FINDINGS

Across the 27 cohort studies included in the review, we found that (1) there was inconclusive evidence on the effect of occupational gender composition on the mental health of men and women, (2) women's mental health was more likely to be affected by long working hours than men's; however, precarious employment was more likely to be negatively associated with men's mental health, (3) exposure to traditional constructs of psychosocial job stressors negatively affected the mental health of both women and men, and (4) unemployment and retirement are associated with poorer mental health in both genders.

INTERPRETATION

The findings from this review indicate that gendered working environments may affect the mental health of both men and women, but the association is dependent on the specific exposure examined. There is still much to be understood about gendered working environments, and future research into work and health should be considered with a gender lens.

The impact of the disability support pension on mental health: evidence from 14 years of an Australian cohort

OBJECTIVE

To assess the effect of the Australian Disability Support Pension (DSP) on the symptomology of depression and anxiety over and above the effects of reporting a disability itself.

METHODS

We used the Household Income Labour Dynamics in Australia (HILDA) survey from 2004 to 2017. We used fixed effects regression to understand mental health differences (using the Mental Health Inventory-5 [MHI-5]) when a person reported: i) a disability; or ii) a disability and receiving the DSP) compared to when they reported no disability. The models controlled for time-varying changes in the severity of the disability and other time-related confounders.

RESULTS

There was a 2.97-point decline (95%CI -3.26 to -2.68) in the MHI-5 when a person reported a disability compared to waves in which they reported no disability and 4.48-point decline (95%CI -5.75 to -3.22) when a person reported both a disability and being on the DSP compared to waves in which they reported neither.

CONCLUSIONS

Results suggest that accessing and being in receipt of the DSP can impact the mental health of people with disabilities. Implications for public health: Government income support policies should address the unintended adverse consequences in already vulnerable populations.

Employment and occupational outcomes following adolescent-onset mental illness: analysis of a nationally representative French cohort

BACKGROUND

There has been little work into the relative effects of adolescent-onset, as compared to lifetime, mental illness on employment, income and occupational outcomes in adulthood.

METHODS

Using data from the Santé et Itinéraire Professionnel Survey, a nationally representative survey of 13 648 French working-age people to investigate prospective associations between self-reported mental illness and employment, income and occupational outcomes. We further investigated whether these outcomes would differ for those reporting an onset of mental illness prior to 18 years of age.

RESULTS

Adolescent-onset mental illness was associated with poorer employment outcomes, significantly increased risk of employment in low-skilled occupations, as well as reduced monthly wage earnings.

CONCLUSIONS

Results extend understandings of the risks of adolescent-onset mental illness on employment and occupational outcomes and suggest that vocational recovery services should take these factors into account when designing support services for adolescents with mental health problems, particularly for males.

Exposure to discrimination and subsequent changes in self-rated health: prospective evidence from the UK's Life Opportunities Survey

OBJECTIVES

We sought to estimate risk of poor self-rated health (SRH) following exposure to disability-related and other forms of overt discrimination in a cohort of working age adults.

STUDY DESIGN

The study design is a population-based cohort survey.

METHODS

Secondary analysis of data collected in Waves 1 and 2 of the UK's Life Opportunities Survey which at Wave 2 involved the participation of 12,789 working age adults. Adjusted prevalence rate ratios were used to estimate the impact of exposure to disability and non-disability discrimination on two measures of SRH at Wave 2, controlling for SRH status at Wave 1.

RESULTS

Exposure to disability discrimination in the previous year was reported by 3.9% of working age British adults. Other forms of discrimination were reported less frequently (age: 3.7%, ethnicity: 2.5%, gender: 1.6%, religion: 0.8%, sexual orientation: 0.4%). In all analyses, there were stronger associations between exposure to disability discrimination and poor SRH at Wave 2 when compared with exposure to other forms of discrimination.

CONCLUSIONS

Disability discrimination represents a violation of human rights. It is also likely to be a major contributor to the health inequities experienced by working age adults with disability.

Physical workload, long-term sickness absence, and the role of social capital. Multi-level analysis of a large occupation cohort

Objectives This study determined the prospective relation between physical workload and long-term sickness absence (LTSA) and examined if work-unit social capital may buffer the effect of high physical workload on LTSA. Methods We included 28 925 participants from the Danish Well-being in HospitAL Employees (WHALE) cohort, and followed them for two years. Physical workload and social capital were self-reported and categorized into low, medium, and high. Physical workload was analyzed on the individual level, whereas social capital was analyzed on the work-unit level. LTSA data were obtained from the employers' payroll system. We performed two-level logistic regression analyses: joint-effect and stratified analyses adjusted for baseline covariates. Results High versus low physical workload was associated with a higher risk of LTSA [odds ratio (OR) 1.55, 95% confidence interval (CI) 1.40-1.72]. There was a multiplicative interaction (P=0.007) and a tendency of sub-additive interaction [relative excess risk due to interaction (RERI) -0.49, 95% CI -1.03-0.06] between physical workload and social capital. Doubly exposed employees had the highest risk of LTSA (OR 2.45; 95% CI 2.02-2.98), but this effect was smaller than expected from the sum of their main effects. Conclusions We found a prospective relation between physical workload and LTSA but no evidence of high social capital buffering the effect of high physical workload. High physical workload was a risk factor for LTSA at all levels of social capital and employees exposed to both exposures had the highest risk of LTSA. Interventions should aim at both improving social capital and reducing physical workload in order to efficiently prevent LTSA.

Differential Exposure to Job Stressors: A Comparative Analysis Between Migrant and Australia-Born Workers

AIMS

Previous studies have suggested that migrants have higher exposures to psychosocial job stressors than native-born workers. We explored migrant status-related differences in skill discretion/job complexity and decision authority, and whether the differences varied by gender, age, and educational attainment.

METHODS

Data were from Wave 14 of the Household Income and Labour Dynamics in Australia (HILDA) Survey. A total number of 9031 persons were included in the analysis. Outcomes included skill discretion/job complexity and decision authority. Exposure included migrant status defined by (i) country of birth (COB), (ii) the combination of COB and English/Non-English dominant language of COB, and (iii) the combination of COB and years since arrival in Australia. Data were analysed using linear regression, adjusting for gender, age, and educational attainment. These covariates were also analysed as effect modifiers of the relationship between migrant status and job stressor exposure.

RESULTS

In the unadjusted analysis, only migrant workers from Non-English-speaking countries (Non-ESC-born) had significantly lower skill discretion and job complexity than Australia-born workers (-0.29, 95% CI: -0.56; -0.01); however, results from fully adjusted models showed that all migrant groups, except migrant workers from Main-English-speaking countries, had significantly lower skill discretion and job complexity than Australia-born workers (overseas-born workers, -0.59, 95% CI: -0.79; -0.38; Non-ESC-born, -1.01, 95% CI: -1.27; -0.75; migrant workers who had arrived ≤5 years ago, -1.33, 95% CI: -1.94; -0.72; arrived 6-10 years ago, -0.92, 95% CI: -1.46; -0.39; and arrived ≥11 years ago, -0.45, 95% CI: -0.67; -0.22). On the contrary, the unadjusted model showed that migrant workers had higher decision authority than Australia-born workers, whereas in the fully adjusted model, no difference in decision authority was found between migrant workers and Australia-born workers. Effect modification results showed that as educational attainment increased, differences in skill discretion and job complexity between Australia-born workers and Non-ESC-born migrants progressively increased; whereas Non-ESC-born migrants with postgraduate degree showed significantly lower decision authority than Australia-born workers.

CONCLUSIONS

This study suggests that skill discretion and job complexity but not decision authority is associated with migrant status. Migrants with high educational attainment from Non-English-speaking countries appear to be most affected by lower skill discretion/job complexity and decision authority; however, differences in skill discretion and job complexity attenuate over time for Non-ESC-born migrants, consistent with an acculturation effect. Low skill discretion and job complexity, to the extent that it overlaps with underemployment, may adversely affect migrant workers' well-being. Targeted language skill support could facilitate migrant integration into the Australian labour market.

Descriptive study of workplace demand, control and bullying among migrant and Australian-born workers by gender: does workplace support make a difference?

OBJECTIVE

The objective of this study is to examine the relationship between bullying in migrants and Australians and types of workplace Iso-strain, by gender.

DESIGN AND SETTING

Two descriptive cross-sectional surveys of the Australian working population.

PARTICIPANTS

Australian-born workers of Caucasian ancestry (n=1051, participant response rate=87.3%) and workers born in New Zealand (n=566), India (n=633) and the Philippines (n=431) (participant response rate=79.5%).

PRIMARY AND SECONDARY OUTCOMES MEASURES

Using logistic regression, we examined whether self-reported assessment of various forms of bullying in the workplace was associated with Iso-strain (job with high demands and low control and without social support), gender and migrant status.

RESULTS

The prevalence of workplace bullying within the previous year was 14.5%. Sexual harassment, though rare (n=47, 1.8%), was reported by more women than men (83% vs 17%, χ²=19.3, p<0.0001) and more Australia or New Zealand born workers compared to India or the Philippines workers (75.5% vs 25.5%, χ²=4.6, p=0.032). Indian-born women had lower adjusted OR for being bullied and for being intimidated compared to other women. Independent of migrant status, Iso-strain (1), (low support from boss) and Iso-strain (2), (low support from colleagues) predicted being bullied. Women were more likely to be in an Iso-strain (1) job than men (18.7% vs 13.6%, p=0.013) and had twice the risk of being both verbally abused and intimidated compared to men (OR 9 vs OR 5.5, p<0.0001).

CONCLUSION

Workplace bullying was more likely for women than men. There were few differences between workers from different migrant groups. Iso-strain was the strongest predictor of workplace bullying. Workplaces should encourage supportive and collegiate work environments.

Psychosocial work exposures of the job strain model and cardiovascular mortality in France: results from the STRESSJEM prospective study

Objectives:

The study aims to explore the prospective associations of the psychosocial work exposures of the job strain model with cardiovascular mortality, including mortality for ischemic heart diseases (IHD) and stroke, using various time-varying exposure measures in the French working population of employees.

Methods:

The study was based on a cohort of 798 547 men and 697 785 women for which job history data from 1976 to 2002 were linked to mortality data and causes of death from the national death registry. Psychosocial work exposures from the validated job strain model questionnaire were assessed using a job-exposure matrix (JEM). Three time-varying measures of exposure were studied: current, cumulative, and recency-weighted cumulative exposure. Cox proportional hazards models were used to examine the associations between psychosocial work exposures and cardiovascular mortality.

Results:

Within the 1976–2002 period, there were 19 264 cardiovascular deaths among men and 6181 among women. Low decision latitude, low social support, job strain, iso-strain, passive job, and high strain were associated with cardiovascular mortality. Most of these associations were also observed for IHD and stroke mortality. The comparison between the different exposure measures suggested that current exposure may be more important than cumulative (or past) exposure. The population fractions of cardiovascular mortality attributable to job strain were 5.64% for men and 6.44% for women.

Conclusions:

Psychosocial work exposures of the job strain model may play a role in cardiovascular mortality. The estimated burden of cardiovascular mortality associated with these exposures underlines the need for preventive policies oriented toward the psychosocial work environment.

Expressions of masculinity and associations with suicidal ideation among young males

BACKGROUND

Adolescent boys and young men are at particular risk of suicide. Suicidal ideation is an important risk factor for suicide, but is poorly understood among adolescent males. Some masculine behaviors have been associated with deleterious effects on health, yet there has been little quantitative examination of associations between masculinity and suicide or suicidal ideation, particularly among boys/young men. This study aimed to examine associations between conformity to masculine norms and suicidal ideation in a sample of adolescents.

METHODS

A prospective cohort design, this study drew on a sample of 829 Australian boys/young men from the Australian Longitudinal Study on Male Health. Boys were 15-18 years at baseline, and 17-20 years at follow-up. Masculine norms (Wave 1), were measured using the Conformity to Masculine Norms Inventory (CMNI-22). Suicidal ideation (Wave 2) was a single-item from the Youth Risk Behavior Survey. Logistic regression analysis was conducted, adjusting for available confounders including parental education, Indigenous Australian identity and area disadvantage.

RESULTS

In adjusted models, greater conformity to violent norms (OR = 1.23, 95% Confidence Interval [CI]: 1.03-1.47) and self-reliance norms (OR = 1.40, 95% CI: 1.15-1.70) was associated with higher odds of reporting suicidal ideation. Greater conformity to norms regarding heterosexuality was associated with reduced odds of reporting suicidal ideation (OR = 0.80, 95% CI: 0.68-0.91).

CONCLUSIONS

These results suggest that conforming to some masculine norms may be deleterious to the mental health of young males, placing them at greater risk of suicidal ideation. The results highlight the importance of presenting young males with alternative and multiple ways of being a male. Facilitating a relaxation of norms regarding self-reliance, and encouraging help-seeking, is vital. Furthermore, dismantling norms that rigidly enforce masculine norms, particularly in relation to heteronormativity, is likely to benefit the broad population of males, not only those who do not conform to heterosexual and other masculine norms.

Do gender and psychosocial job stressors modify the relationship between disability and sickness absence: An investigation using 12 waves of a longitudinal cohort

Objectives A considerable proportion of the working population reports a disability. These workers may be at risk of adverse outcomes, including longer periods of sickness absence. This study examined the causal effect of disability on sickness absence and the role of psychosocial job stressors and gender as effect modifiers. Methods Data on paid and unpaid sick leave, disability (yes/no) and psychosocial job stressors were available from 2005 to 2017 from the Household, Income and Labour Dynamics in Australia (HILDA) survey. Negative binomial models were used to model the rate of sickness absence in a year. Results In the random effects model, workers with disability had 1.20 greater rate of sickness absence in a year [95% confidence interval (CI) 1.17-1.23, P<0.001] after adjustment for confounders. The rate was slightly lower in the fixed effects model. There was evidence of multiplicative interaction of the effect by gender and job control. The effect of disability on sickness absence was greater among men than women, and higher for people with low job control compared to those with high job control. Conclusions There is a need for more research about the factors that can reduce sickness leave among workers with disabilities.

Association of suicidal behavior with exposure to suicide and suicide attempt: A systematic review and multilevel meta-analysis

BACKGROUND

Exposure to suicidal behavior may be associated with increased risk of suicide, suicide attempt, and suicidal ideation and is a significant public health problem. However, evidence to date has not reliably distinguished between exposure to suicide versus suicide attempt, nor whether the risk differs across suicide-related outcomes, which have markedly different public health implications. Our aim therefore was to quantitatively assess the independent risk associated with exposure to suicide and suicide attempt on suicide, suicide attempt, and suicidal ideation outcomes and to identify moderators of this risk using multilevel meta-analysis.

METHODS AND FINDINGS

We systematically searched MEDLINE, Embase, PsycINFO, CINAHL, ASSIA, Sociological Abstracts, IBSS, and Social Services Abstracts from inception to 19 November 2019. Eligible studies included comparative data on prior exposure to suicide, suicide attempt, or suicidal behavior (composite measure-suicide or suicide attempt) and the outcomes of suicide, suicide attempt, and suicidal ideation in relatives, friends, and acquaintances. Dichotomous events or odds ratios (ORs) of suicide, suicide attempt, and suicidal ideation were analyzed using multilevel meta-analyses to accommodate the non-independence of effect sizes. We assessed study quality using the National Heart, Lung, and Blood Institute quality assessment tool for observational studies. Thirty-four independent studies that presented 71 effect sizes (exposure to suicide: k = 42, from 22 independent studies; exposure to suicide attempt: k = 19, from 13 independent studies; exposure to suicidal behavior (composite): k = 10, from 5 independent studies) encompassing 13,923,029 individuals were eligible. Exposure to suicide was associated with increased odds of suicide (11 studies, N = 13,464,582; OR = 3.23, 95% CI = 2.32 to 4.51, P < 0.001) and suicide attempt (10 studies, N = 121,836; OR = 2.91, 95% CI = 2.01 to 4.23, P < 0.001). However, no evidence of an association was observed for suicidal ideation outcomes (2 studies, N = 43,354; OR = 1.85, 95% CI = 0.97 to 3.51, P = 0.06). Exposure to suicide attempt was associated with increased odds of suicide attempt (10 studies, N = 341,793; OR = 3.53, 95% CI = 2.63 to 4.73, P < 0.001), but not suicide death (3 studies, N = 723; OR = 1.64, 95% CI = 0.90 to 2.98, P = 0.11). By contrast, exposure to suicidal behavior (composite) was associated with increased odds of suicide (4 studies, N = 1,479; OR = 3.83, 95% CI = 2.38 to 6.17, P < 0.001) but not suicide attempt (1 study, N = 666; OR = 1.10, 95% CI = 0.69 to 1.76, P = 0.90), a finding that was inconsistent with the separate analyses of exposure to suicide and suicide attempt. Key limitations of this study include fair study quality and the possibility of unmeasured confounders influencing the findings. The review has been prospectively registered with PROSPERO (CRD42018104629).

CONCLUSIONS

The findings of this systematic review and meta-analysis indicate that prior exposure to suicide and prior exposure to suicide attempt in the general population are associated with increased odds of subsequent suicidal behavior, but these exposures do not incur uniform risk across the full range of suicide-related outcomes. Therefore, future studies should refrain from combining these exposures into single composite measures of exposure to suicidal behavior. Finally, future studies should consider designing interventions that target suicide-related outcomes in those exposed to suicide and that include efforts to mitigate the adverse effects of exposure to suicide attempt on subsequent suicide attempt outcomes.

The cumulative effect of living with disability on mental health in working-age adults: an analysis using marginal structural models

PURPOSE

Previous studies have shown that acquiring a disability is associated with a reduction in mental health, but they have not considered the cumulative impact of having a disability on mental health. We used acquisition of a non-psychological disability to estimate the association of each additional year lived with disability on mental health (measured using the Mental Component Summary score of the Short Form Health Survey).

METHODS

We used the first 13 waves of data (years 2001-2013) from the Household, Income and Labour Dynamics in Australia Survey. The sample included 4113 working-age (18-65 years) adults who were disability-free at waves 1 and 2. We fitted marginal structural models with inverse probability weights to estimate the association of each additional year of living with disability on mental health, employing multiple imputation to handle the missing data.

RESULTS

Of the 4113 participants, 7.7 percent acquired a disability. On average, each additional year lived with disability was associated with a decrease in the mean Mental Component Summary score (β = - 0.42; 95% CI - 0.71, - 0.14).

CONCLUSIONS

This study provides evidence that each additional year lived with non-psychological disability is associated with a decline in mental health among working-age Australians.

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.

Working hours, common mental disorder and suicidal ideation among junior doctors in Australia: a cross-sectional survey

OBJECTIVE

Despite concern regarding high rates of mental illness and suicide amongst the medical profession, the link between working hours and doctors' mental health remains unclear. This study examines the relationship between average weekly working hours and junior doctors' (JDs') mental health in Australia.

DESIGN AND PARTICIPANTS

A randomly selected sample of 42 942 Australian doctors were invited to take part in an anonymous Beyondblue National Mental Health Survey in 2013, of whom 12 252 doctors provided valid data (response rate approximately 27%). The sample of interest comprised 2706 full-time graduate medical trainees in various specialties, at either intern, prevocational or vocational training stage. Consultants and retired doctors were excluded.

OUTCOME MEASURES

Main outcomes of interest were caseness of common mental disorder (CMD) (assessed using a cut-off of 4 as a threshold on total General Health Questionnaire-28 score), presence of suicidal ideation (SI) (assessed with a single item) and average weekly working hours. Logistic regression modelling was used to account for the impact of age, gender, stage of training, location of work, specialty, marital status and whether JDs had trained outside Australia.

RESULTS

JDs reported working an average of 50.1 hours per week (SD=13.4). JDs who worked over 55 hours a week were more than twice as likely to report CMD (adjusted OR=2.05; 95% CI 1.62 to 2.59, p<0.001) and SI (adjusted OR=2.00; 95% CI 1.42 to 2.81, p<0.001) compared to those working 40-44 hours per week.

CONCLUSIONS

Our results show that around one in four JDs are currently working hours that are associated with a doubling of their risk of common mental health problems and SI. These findings suggest that management of working hours represents an important focus for workplaces to improve the mental health of medical trainees.

Does the effect of disability acquisition on mental health differ by employment characteristics? A longitudinal fixed-effects analysis

PURPOSE

Longitudinal studies have suggested a causal relationship between disability acquisition and mental health, but there is substantial heterogeneity in the magnitude of the effect. Previous studies have provided evidence that socioeconomic characteristics can buffer the effect but have not examined the role of employment characteristics.

METHODS

We used data from 17 annual waves of the Household, Income and Labour Dynamics in Australia Survey to compare the mental health of working age individuals before and after disability acquisition, using the Mental Health Inventory, a subscale of the SF-36 health questionnaire. Linear fixed-effects regression models were used to estimate the effect of disability acquisition on mental health. We tested for effect modification by two characteristics of people's employment prior to disability acquisition: occupational skill level and contract type. Multiple imputation using chained equations was used to handle missing data.

RESULTS

Disability acquisition was associated with a substantial decline in mental health score (estimated mean difference: - 4.3, 95% CI - 5.0, - 3.5). There was evidence of effect modification by occupational skill level, with the largest effects seen for those in low-skilled jobs (- 6.1, 95% CI - 7.6, - 4.5), but not for contract type.

CONCLUSIONS

The findings highlight the need for social and health policies that focus on increasing employment rates, improving the sustainability of employment, and providing employment services and education and training opportunities for people who acquire a disability, particularly for people in low-skilled occupations, to reduce the mental health inequalities experienced by people with disabilities.

Treatment-seeking differences for mental health problems in male- and non-male-dominated occupations: evidence from the HILDA cohort

BACKGROUND

There is a well-established gender divide among people who do and do not seek professional help from mental health professionals. Females are typically more likely to report, and seek help for, mental health problems. The current paper sought to examine the role of employment context on help-seeking for mental health issues. We hypothesised that men and women in male-dominated occupations would be less likely to seek help than those in non-male-dominated occupations.

METHODS

Data from the Household, Income and Labour Dynamics in Australia survey were used. Help-seeking, measured in 2013, was defined as whether a person reported attending a mental health professional in the 12 months prior to the survey. The exposure, male- and non-male-dominated occupations (measured in 2012), was defined using census data based on self-reported occupation. Analyses were stratified by gender and controlled for relevant confounders (measured in 2012), including mental health and prior help-seeking. We conducted multivariate logistic and propensity score analyses to improve exchangeability of those exposed and unexposed.

RESULTS

For males, being in a male-dominated occupation was independently associated with reduced likelihood of help-seeking (OR 0.66, 95% CI 0.46-0.95) in the adjusted model, although this result fell just out of significance in the propensity score analysis. There was no independent effect of being in a male-/non-male-dominated occupation for help-seeking among women.

CONCLUSIONS

Results suggest that male-dominated occupations may negatively influence help-seeking among males. There is a need for more research to understand this relationship and for workplace-based prevention initiatives.

Multicohort study of change in job strain, poor mental health and incident cardiometabolic disease

OBJECTIVES

Several recent large-scale studies have indicated a prospective association between job strain and coronary heart disease, stroke and diabetes. Job strain is also associated with poorer mental health, a risk factor for cardiometabolic disease. This study investigates the prospective relationships between change in job strain, poor mental health and cardiometabolic disease, and whether poor mental health is a potential mediator of the relationship between job strain and cardiometabolic disease.

METHODS

We used data from five cohort studies from Australia, Finland, Sweden and UK, including 47 757 men and women. Data on job strain across two measurements 1-5 years apart (time 1 (T1)-time 2 (T2)) were used to define increase or decrease in job strain. Poor mental health (symptoms in the top 25% of the distribution of the scales) at T2 was considered a potential mediator in relation to incident cardiometabolic disease, including cardiovascular disease and diabetes, following T2 for a mean of 5-18 years.

RESULTS

An increase in job strain was associated with poor mental health (HR 1.56, 95% CI 1.38 to 1.76), and a decrease in job strain was associated with lower risk in women (HR 0.70, 95% CI 0.60-0.84). However, no clear association was observed between poor mental health and incident cardiometabolic disease (HR 1.08, 95% CI 0.96-1.23), nor between increase (HR 1.01, 95% CI 0.90-1.14) and decrease (HR 1.08, 95% CI 0.96-1.22) in job strain and cardiometabolic disease.

CONCLUSIONS

The results did not support that change in job strain is a risk factor for cardiometabolic disease and yielded no support for poor mental health as a mediator.

Prospective associations of psychosocial work exposures with mortality in France: STRESSJEM study protocol

INTRODUCTION

Although evidence has been provided on the associations between psychosocial work exposures and morbidity outcomes in the literature, knowledge appears much more sparse on mortality outcomes. The objective of STRESSJEM is to explore the prospective associations between psychosocial work exposures and mortality outcomes among the national French working population. In this paper, we describe the study protocol, study population, data sources, method for exposure assessment, data analysis and future plans.

METHODS AND ANALYSIS

Data sources will include: the data from the national SUMER survey from DARES on the evaluation of psychosocial work exposures and the data from the COSMOP programme from Santé publique France linking job history (DADS data from INSEE) and mortality according to causes of death (data from the national death registry, INSERM-CépiDc). A sample of 1 511 456 individuals will form the studied prospective cohort for which data are available on both job history and mortality over the period 1976-2002. Psychosocial work exposures will be imputed via a job-exposure matrix using three job title variables that are available in both the SUMER and COSMOP data sets. Our objectives will be to study the associations between various psychosocial work exposures and mortality outcomes. Psychosocial work exposures will include the job strain model factors as well as other psychosocial work factors. Various measures of exposure over time will be used. All-cause and cause-specific mortality will be studied.

ETHICS AND DISSEMINATION

Both the SUMER survey and the COSMOP programme have been approved by French ethics committees. Dissemination of the study results will include a series of international peer-reviewed papers and at least one paper in French. The results will be presented in national and international conferences. This project will offer a unique opportunity to explore mortality outcomes in association with psychosocial work exposures in a large national representative sample of the working population.

An intersectional approach to understandings of mental health inequalities among men with disability

Disability is a key social identity or social category that is associated with significant social disadvantage. For men, having a disability can be discordant with their masculine identity. Self-reliance is one component of masculinity that is known to be important to men with disabilities, however it is also known to be associated with adverse mental health outcomes in the broader adult male population. Intersectionality approaches offer a means of examining the way that the effect of self-reliance on mental health might vary between those with and without a disability. Among a sample of 12,052 men aged 18-55 years from the Ten-to-Men study, we used effect measure modification (EMM) to examine the way that self-reliance modifies the relationship between disability and depressive symptoms. Disability was assessed using the Washington Group Short Set of questions, which capture functional limitations. Results showed that men with disabilities who reported higher conformity to self-reliance norms had much worse mental health than non-disabled men with low conformity to self-reliance, as measured in terms of depressive symptoms (PRR: 9.40, 95%CI 7.88, 11.22, p-value<0.001). We found evidence of positive EMM of depressive symptoms by conformity to self-reliance on the additive scale (RERI: 2.84, 95%CI 1.26, 4.42, p-value<0.001). These results provide evidence that high conformity to self-reliance norms exerts a particularly damaging effect on the mental health of men with disabilities. Given that men with disabilities are more likely to rely on help and support from others, these results provide important insights for the delivery of services to men with disability.

A comparison of face-to-face and online training in improving managers' confidence to support the mental health of workers

BACKGROUND

In recognition of the important role managers play in the well-being of the staff they supervise, many workplaces are implementing specialised training for leaders to help them better understand and support the mental health needs of their staff. This training can be delivered through face-to-face or online training sessions. Evaluation of such programs have found positive results for each format when compared to a control group, but to date, face-to-face and online manager mental health training have not been compared with one another.

AIMS

This study brings together results from two trials evaluating the same program content, each employing a different mode of content delivery. Both types of training aimed to change managers' confidence to better support the mental health needs of the staff they supervise.

METHODS

Utilising data derived from two previously conducted trials, mean change in manager confidence from baseline at both post-intervention and follow-up were examined for each method of content delivery. An identical way of measuring confidence was used in each study.

RESULTS

Managers' confidence improved from baseline with both methods of training. A greater change was observed with face-to-face training than for online, although both methods had sustained improvement over time. Analyses indicate that at follow-up, improvements in confidence were significant for both face-to-face (t ₁₈  = 5.99; P < .001) and online training (t ₃₉  = 3.85; P < .001). Analyses focused on managers who fully completed either type of training indicated very similar impacts for face-to-face and online training.

CONCLUSIONS

Both face-to-face and online delivery of manager mental health training can significantly improve managers' confidence in supporting the mental health needs of their staff. This change is sustained over various follow-up periods. However, lower retention rates common in online training reduce the relative effect of this method of delivery.

Branchio-otic syndrome: An opportunity to reassess the paediatric anaesthetists’ approach to the difficult syndromic airway

Branchio-oto-renal spectrum disorders are rare genetic entities with variable penetrance and concurrently display a wide phenotypic variation. A common issue to syndromic children is a propensity for difficult bag-mask ventilation, intubation or both. Unfortunately, there is no uniformity of this challenge, assessment strategy or management plan. This case with features of branchio-otic syndrome provided the opportunity to examine several aspects of paediatric anaesthetic airway management. The child was booked for branchial cyst removal but appeared to have other features of abnormal branchial cleft development. An outline of the executed anaesthetic plan is presented and discussed. Three different techniques were sequentially tried in this patient before the airway was secured. Various case reports in the literature inconsistently describe easy to very difficult airway management in children with branchio-oto-renal spectrum disorders. Branchial arch dysgenesis is almost always associated with difficult direct laryngoscopy. There is undoubtedly no singular way to ideally manage a child with a difficult airway. Many tools for difficult airways are available. However, despite the improvement of difficult paediatric airway equipment, it would appear that for the anaesthetist the flexible bronchoscope remains an indispensable tool.

Disabling working environments and mental health: A commentary

Employment is a fundamental Social Determinant of Health known to have large impacts on mental health and other health outcomes. Across many countries of the world, people with disabilities are much more likely to be unemployed and looking for work than those without disabilities. The deprivation of employment opportunities is likely to have notable impacts on the health of people with disabilities. In this commentary, we outline the concept of "disabling working environments," which are defined as the range of experiences that affect the likelihood of people with disabilities in obtaining and maintaining quality employment which may then affect a disabled person's health. Disabling working environments are comprised of the following three mutually reinforcing components: 1) Differential selection into work; 2) Selection into certain types of jobs and exposure to poor psychosocial working environments when in employment, and; 3) Differential selection out of work (e.g., leaving employment at an earlier age than those who do not have a disability). We argue that policy and intervention design should consider the life course effects of employment on the mental health of people with disabilities.

Job Stressors and Employment Precarity as Risks for Thoughts About Suicide: An Australian Study Using the Ten to Men Cohort

Aims

Past research suggests that adverse experiences at work (such as job stressors and precarious employment) are associated with thoughts about suicide, especially among males. A limitation of this research is that it is largely cross-sectional. Thus, it is unknown whether job stressors are a prior cause of thoughts about suicide. This study examined the baseline association between adverse experiences at work and thoughts about suicide at follow-up in a large nationally representative cohort of employed men.

Methods

We used data from the Australian Longitudinal Study on Male Health (Ten to Men). The outcome was thoughts about suicide in the prior 12 months (reported in wave 2) and the key exposure variables were: high job demands, low job control, job insecurity, perceived unfairness of pay, occupational skill level, and employment arrangement (all reported in wave 1). We adjusted for possible confounders, including mental health and suicidal thoughts (wave 1).

Results

In a sample of 8379 and after adjustment, job insecurity (OR 1.35, 95% CI 1.13-1.61, P = 0.001), low job control (OR 1.19, 95% CI 1.06-1.33, P = 0.004), and employment on a casual or on a fixed term basis (OR 1.30, 95% 1.01-1.67, P = 0.041) were associated with a greater odds of thoughts about suicide at follow up. Results for all by job control were maintained after removing those who reported thoughts of suicide at baseline.

Conclusion

This study suggests that experiences at work may be risk factors for thoughts about suicide among employed men. More research is needed to unpack the complex associations between, employment, and experiences of suicide.

To what extent is the association between disability and mental health in adolescents mediated by bullying? A causal mediation analysis

Background

Disability among adolescents is associated with both poorer mental health (MH) and higher levels of bullying-victimization. Bullying, therefore, conceivably mediates the association between disability and MH. Quantifying this pathway is challenging as the exposure (disability), mediator (bullying) and outcome (MH) are subjective, and subject to dependent measurement error if the same respondent reports on two or more variables.

Methods

Utilizing the counterfactual and potential outcomes approaches to causal mediation, we decomposed the total effect of disability on MH into natural indirect effects (through bullying) and natural direct effects (not through bullying) using a sample of 3409 adolescents. As the study included data from multiple informants (teacher, parent, adolescent) on the outcome (MH, as measured on the Strengths and Difficulties Questionnaire) and two informants (adolescent, parent) on the mediator (bullying), we assessed the influence of dependent measurement error.

Results

For preferred analysis (using parent-reported bullying and adolescent-reported MH), the total effect was a 2.18 [95% confidence interval (CI): 0.66-3.40] lower MH score for adolescents with a disability, compared with those with no disability (strength of association equivalent to 37% of the standard deviation for MH). Bullying explained 46% of the total effect. Use of adolescent-reported bullying with adolescent-reported MH produced similar results (37% mediation, 95% CI: 12-74%).

Conclusions

Disability exerts a detrimental effect on adolescent MH, and a large proportion of this appears to operate through bullying. This finding does not appear to be spurious due to dependent measurement error.