[Does unemployment cause illness? A review of the status of knowledge of the correlation between unemployment, physical and psychological health risks].

Unemployment appears to be a complex condition that burdens the individuals affected in multiple ways both at job loss and in long-term unemployment. To a lesser extent unemployment may also relieve the stressors and risks associated with the place of work. The scope and nature of the burden experienced depends on individual factors, such as mental stability and coping resources, on economic, social and cultural factors, such as availability of alternative roles, system of social security and social context. In the industralized countries, especially in the Federal Republic of Germany, financial security and society's attitudes towards unemployment are less unfavourable than during the economic recession between the two world wars. Nevertheless, household income should not be overlooked as an important factor leading to stress beyond a certain threshold. In this respect it is noteworthy that the income of the unemployed households in the Federal Republic of Germany decreased by 8% between 1981 and 1983 (Brinkmann, 1986). Quantitative relationships between unemployment and physical health have frequently been reported. In studies whose designs allow such associations to be explained selection factors, i.e. an overrepresentation of frequently or chronically ill and disabled individuals among those losing their jobs and the long-term unemployed, contribute to the increased morbidity among the unemployed to a considerable extent. Causal relationships between unemployment and physical health risks have not yet been proven directly, which does not mean that there are none. The mediation of health risks by changes in behaviour during unemployment which as such might lead to or reduce morbidity and mortality risks has not yet been studied sufficiently. Unemployment appears to have both an increasing and a reducing effect, but also no effect at all on the use of alcohol and tobacco in different populations. But we do not yet know enough about the mechanisms bringing about these effects. There are more consistent findings indicating that sustained unemployment influences personal well-being. This influence is reflected primarily in unspecific physical complaints and mild or moderately severe depressive changes of mood. The most important finding of increased health risks in the unemployed versus the employed are elevated rates of suicide and attempted suicide. This finding, too, seems to be attributable to selection factors, i.e. predominantly to an overrepresentation of mental disorders and substance abuse associated with an increased suicide risk among job-losers.(ABSTRACT TRUNCATED AT 400 WORDS)