Schuring Merel, Robroek Suzan Jw, Burdorf Alex
Erasmus University Medical Center, Department of Public Health, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
Scand J Work Environ Health. 2017 Nov 1;43(6):540-549. doi: 10.5271/sjweh.3675. Epub 2017 Oct 2.
Objectives The aims of this study were to (i) investigate the impact of paid employment on self-rated health, self-esteem, mastery, and happiness among previously unemployed persons with common mental health problems, and (ii) determine whether there are educational inequalities in these effects. Methods A quasi-experimental study was performed with a two-year follow-up period among unemployed persons with mental health problems. Eligible participants were identified at the social services departments of five cities in The Netherlands when being diagnosed with a common mental disorder, primarily depression and anxiety disorders, in the past 12 months by a physician (N=749). Employment status (defined as paid employment for ≥12 hours/week), mental health [Short Form 12 (SF-12)], physical health (SF-12), self-esteem, mastery, and happiness were measured at baseline, after 12 months and 24 months. The repeated-measurement longitudinal data were analyzed using a hybrid method, combining fixed and random effects. The regression coefficient was decomposed into between- and within-individual associations, respectively. Results The between-individuals associations showed that persons working ≥12 hours per week reported better mental health (b=26.7, SE 5.1), mastery (b=2.7, SE 0.6), self-esteem (b=5.7, SE 1.1), physical health (b=14.6, SE 5.6) and happiness (OR 7.7, 95% CI 2.3-26.4). The within-individual associations showed that entering paid employment for ≥12 hours per week resulted in better mental health (b=16.3, SE 3.4), mastery (b=1.7, SE 0.4), self-esteem (b=3.4, SE 0.7), physical health (b=9.8, SE 2.9), and happiness (OR 3.1, 95% CI 1.4-6.9). Among intermediate- and high-educated persons, entering paid employment had significantly larger effect on mental health than among low-educated persons. Conclusions This study provides evidence that entering paid employment has a positive impact on self-reported health; thus work should be considered as an important part of health promotion programs among unemployed persons.
目的 本研究的目的是：（i）调查有偿就业对先前失业且有常见心理健康问题者的自评健康、自尊、掌控感和幸福感的影响；（ii）确定这些影响中是否存在教育不平等。方法 对有心理健康问题的失业者进行了一项为期两年随访期的准实验研究。当荷兰五个城市的社会服务部门诊断出在过去12个月内患有常见精神障碍（主要是抑郁症和焦虑症）的人时，确定符合条件的参与者（N = 749）。在基线、12个月和24个月时测量就业状况（定义为每周有偿工作≥12小时）、心理健康[简短健康调查问卷12项（SF - 12）]、身体健康（SF - 12）、自尊、掌控感和幸福感。使用结合固定效应和随机效应的混合方法分析重复测量的纵向数据。回归系数分别分解为个体间和个体内关联。结果 个体间关联表明，每周工作≥12小时的人报告的心理健康状况更好（b = 26.7，标准误5.1）、掌控感更强（b = 2.7，标准误0.6）、自尊更高（b = 5.7，标准误1.1）、身体健康状况更好（b = 14.6，标准误5.6）以及幸福感更强（比值比7.7，95%置信区间2.3 - 26.4）。个体内关联表明，每周进入有偿就业≥12小时会带来更好的心理健康（b = 16.3，标准误3.4）、掌控感（b = 1.7，标准误0.4）、自尊（b = 3.4，标准误0.7）、身体健康（b = 9.8，标准误2.9）和幸福感（比值比3.1，95%置信区间1.4 - 6.9）。在中等教育和高等教育人群中，进入有偿就业对心理健康的影响比对低教育人群的影响显著更大。结论 本研究提供了证据表明进入有偿就业对自我报告的健康有积极影响；因此，工作应被视为失业者健康促进计划的重要组成部分。
