The Impact of Unemployment on Health: A Review of the Evidence

Occupational Health Section (Medical Services Department), Workers' Compensation Board of British Columbia, Vancouver.
Canadian Medical Association Journal (Impact Factor: 5.96). 10/1995; 153(5):529-40. DOI: 10.2307/3343311
Source: PubMed

ABSTRACT To review the scientific evidence supporting an association between unemployment and adverse health outcomes and to assess the evidence on the basis of the epidemiologic criteria for causation.
MEDLINE was searched for all relevant articles with the use of the MeSH terms "unemployment," "employment," "job loss," "economy" and a range of mortality and morbidity outcomes. A secondary search was conducted for references from the primary search articles, review articles or published commentaries. Data and definitions of unemployment were drawn from Statistics Canada publications.
Selection focused on articles published in the 1980s and 1990s. English-language reports of aggregate-level research (involving an entire population), such as time-series analyses, and studies of individual subjects, such as cross-sectional, case-control or cohort studies, were reviewed. In total, the authors reviewed 46 articles that described original studies.
Information was sought on the association (if any) between unemployment and health outcomes such as mortality rates, specific causes of death, incidence of physical and mental disorders and the use of health care services. Information was extracted on the nature of the association (positive or negative), measures of association (relative risk, odds ratio or standardized mortality ratio), and the direction of causation (whether unemployment caused ill health or vice versa).
Most aggregate-level studies reported a positive association between national unemployment rates and rates of overall mortality and mortality due to cardiovascular disease and suicide. However, the relation between unemployment rates and motor-vehicle fatality rates may be inverse. Large, census-based cohort studies showed higher rates of overall mortality, death due to cardiovascular disease and suicide among unemployed men and women than among either employed people or the general population. Workers laid off because of factory closure have reported more symptoms and illnesses than employed people; some of these reports have been validated objectively. Unemployed people may be more likely than employed people to visit physicians, take medications or be admitted to general hospitals. A possible association between unemployment and rates of admission to psychiatric hospitals is complicated by other institutional and environmental factors.
Evaluated on an epidemiologic basis, the evidence suggests a strong, positive association between unemployment and many adverse health outcomes. Whether unemployment causes these adverse outcomes is less straightforward, however, because there are likely many mediating and confounding factors, which may be social, economic or clinical. Many authors have suggested mechanisms of causation, but further research is needed to test these hypotheses.

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    • "obvious financial hardship (Feather 1990; Kessler et al. 1989; McKee-Ryan et al. 2005; Wanberg 1995). Although making truly causal inferences is as yet unfounded, research has shown that unemployment is consistently associated with negative outcomes such as heart disease, depression, anxiety, alcohol abuse, mortality, and even suicide (Jin et al. 1995; Wanberg, 2012). "
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    ABSTRACT: Using a national sample, this study investigated the effects of unemployed workers’ coping resources and coping strategy use on reemployment after a three-month period. Based on previous research, it was expected that (1) three types of coping resources (self-esteem, social support, and financial resources) would be positively related to problem-focused coping with job loss, (2) coping resources would be negatively related to emotion-focused coping with job loss, (3) problem-focused coping would be positively related to reemployment, (4) problem-focused coping would be more strongly related to reemployment than emotion-focused coping, and (5) coping strategies would mediate the relationship between the availability of coping resources and obtaining reemployment. Results provided support for the direct effects of coping resources (self-esteem, social support, and, to some extent, financial resources) on coping strategies, and a direct effect of problem-focused coping on reemployment 3 months later. Self-esteem and social support were each indirectly related to subsequent employment status, mediated by problem-focused coping. In other words, individuals with higher levels of self-esteem and social support were not only more likely to engage in problem-focused coping, but having a higher level of self-esteem and social support was also associated with a higher likelihood of being reemployed three months later. Findings are pertinent for the design of more effective interventions that mitigate adverse effects of unemployment and facilitate a successful return to the workforce.
    Journal of Business and Psychology 09/2014; 30(3). DOI:10.1007/s10869-014-9380-7 · 1.25 Impact Factor
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    • "There is a large body of research exploring the connection between working life and health, including the examination of employment status and episodes of unemployment on health and mortality [4,5]. Many of these studies focus on cardiovascular disease (CVD), likely reflecting the high prevalence and mortality of its associated conditions. "
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    ABSTRACT: Background There is growing evidence to suggest unemployment has a role in the development and incidence of cardiovascular disease. This study explores the contribution of breaks in employment to the development of hypertension, a key risk factor for coronary heart disease. Methods We use data from the Survey of Health, Ageing, and Retirement in Europe to estimate the association between gaps in employment of 6 months or more (‘Not Working’, NW) and the incidence of hypertension in 9,985 individuals aged 50 or over across 13 European countries. Life history information including transitions in and out of employment was used to create a panel dataset where each visit represented one year of life between age 30 and incident hypertension or censoring (whichever came first). Pooled logistic models estimated the odds of hypertension according to the experience of not working, controlling for age at interview, age at each visit, gender, childhood socio-economic position, and country. Results We consistently found no association between NW and hypertension, irrespective of the metrics used in defining the exposure or model specification. Conclusion There is the possibility of bias contributing to the null findings. However, given the relatively consistent evidence for an association between unemployment and cardiovascular outcomes in the literature, our results suggest there may be mechanisms - outside of hypertension – that have a comparatively greater contribution to this association.
    BMC Public Health 05/2014; 14(1):536. DOI:10.1186/1471-2458-14-536 · 2.26 Impact Factor
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    • "This study provides further empirical evidence of the countercyclical relationship between economic conditions, health status, and all-cause mortality; health status worsens and mortality rates increase during economic downturns (Brenner and Mooney 1983; Browning and Moller Dano 2006; Catalano 1991; Catalano et al. 2011; Dooley et al. 1996; Franks et al. 2003; Frey 1982; Kasl et al. 1975; Moser et al. 1987; Neumayer 2004; Tapia Granados 2005). Most previous research uses the unemployment rate to evaluate associations between economic recessions and health (Catalano 2009; Idler and Benyamini 1997; Jin et al. 1995; Roelfs et al. 2011). This study employs both unemployment and labor force participation measures to proxy economic conditions. "
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    ABSTRACT: The healthcare sector was one of the few sectors of the US economy that created new positions in spite of the recent economic downturn. Economic contractions are associated with worsening morbidity and mortality, declining private health insurance coverage, and budgetary pressure on public health programs. This study examines the causes of healthcare employment growth and workforce composition in the US and evaluates the labor market's impact on healthcare spending and health outcomes. Data are collected for 50 states and the District of Columbia from 1999-2009. Labor market and healthcare workforce data are obtained from the Bureau of Labor Statistics. Mortality and health status data are collected from the Centers for Disease Control and Prevention's Vital Statistics program and Behavioral Risk Factor Surveillance System. Healthcare spending data are derived from the Centers for Medicare and Medicaid Services. Dynamic panel data regression models, with instrumental variables, are used to examine the effect of the labor market on healthcare spending, morbidity, and mortality. Regression analysis is also performed to model the effects of healthcare spending on the healthcare workforce composition. All statistical tests are based on a two-sided alpha significance of p<.05. Analyses are performed with STATA and SAS. The labor force participation rate shows a more robust effect on healthcare spending, morbidity, and mortality than the unemployment rate. Study results also show that declining labor force participation negatively impacts overall health status (p<.01), and mortality for males (p<.05) and females (p<.001), aged 16-64. Further, the Medicaid and Medicare spending share increases as labor force participation declines (p<.001); whereas, the private healthcare spending share decreases (p<.001). Public and private healthcare spending also has a differing effect on healthcare occupational employment per 100,000 people. Private healthcare spending positively impacts primary care physician employment (p<.001); whereas, Medicare spending drives up employment of physician assistants, registered nurses, and personal care attendants (p<.001). Medicaid and Medicare spending has a negative effect on surgeon employment (p<.05); the effect of private healthcare spending is positive but not statistically significant. Labor force participation, as opposed to unemployment, is a better proxy for measuring the effect of the economic environment on healthcare spending and health outcomes. Further, during economic contractions, Medicaid and Medicare's share of overall healthcare spending increases with meaningful effects on the configuration of state healthcare workforces and subsequently, provision of care for populations at-risk for worsening morbidity and mortality.
    International Journal of Health Care Finance and Economics 03/2014; 14(2). DOI:10.1007/s10754-014-9142-0 · 0.49 Impact Factor
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