Béland François, Birch Stephen, Stoddart Greg
Groupe de recherche interdisciplinaire en santé, GRIS, Faculté de Médecine, Université de Montréal, CP 6128, Succursale Centre-Ville, Montréal H3C 3J7, Québec, Canada.
Soc Sci Med. 2002 Dec;55(11):2033-52. doi: 10.1016/s0277-9536(01)00344-6.
While there is a large and growing literature investigating the relationship between an individual's employment status and health, considerably less is known about the effect on this relationship of the context in which unemployment occurs. The aim of this paper is test for the presence and nature of contextual effects in the ways unemployment and health are related, based on a simple underlying model of stress, social support and health using a large population health survey. An individual's health can be influenced directly by own exposure to unemployment and by exposure to unemployment in the individual's context, and indirectly by the effects these exposures have on the relationship between other health determinants and health. Based on this conceptualization an empirical model, using multi-level analysis, is formulated that identifies a five-stage process for exploring these complex pathways through which unemployment affects health. Results showed that the association of individual unemployment with perceived health is statistically significant. Nevertheless, this study did not provide evidence to support the hypothesis that the association of unemployment with health status depends upon whether the experience of unemployment is shared with people living in the same environment. Above all, this study demonstrates both the subtlety and complexity of individual- and contextual-level influences on the health of individuals. Our results caution against simplistic interpretations of the unemployment-health relationship and reinforce the importance of using multi-level statistical methods for investigation of it.
虽然有大量且不断增加的文献在研究个人就业状况与健康之间的关系，但对于失业发生背景对这种关系的影响却知之甚少。本文的目的是基于压力、社会支持和健康的简单基础模型，利用一项大规模人口健康调查，检验失业与健康之间关系中背景效应的存在及其性质。个人的健康可直接受到自身失业经历以及所处环境中他人失业情况的影响，也会间接受这些经历对其他健康决定因素与健康之间关系的影响。基于这一概念化内容，构建了一个使用多层次分析的实证模型，该模型确定了一个五阶段过程，用于探究失业影响健康的这些复杂路径。结果表明，个人失业与自我感知健康之间的关联具有统计学意义。然而，本研究并未提供证据支持以下假设：失业与健康状况之间的关联取决于失业经历是否与生活在同一环境中的人相同。最重要的是，本研究证明了个人层面和背景层面影响个人健康的微妙性和复杂性。我们的研究结果提醒人们不要对失业与健康的关系进行简单化解读，并强调了使用多层次统计方法进行调查的重要性。
