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


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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    • "This parallels the lagged effect of 1–2 months noticed within South Australian EDs in our study. There is also evidence that unemployment leads to increased presentation to general practitioners[22]. "
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    ABSTRACT: Background: To determine the extent to which variations in monthly Mental Health Emergency Department (MHED) presentations in South Australian Public Hospitals are associated with the Australian Bureau of Statistics (ABS) monthly unemployment rates. Methods: Times series modelling of relationships between monthly MHED presentations to South Australian Public Hospitals derived from the Integrated South Australian Activity Collection (ISAAC) data base and the ABS monthly unemployment rates in South Australia between January 2004-June 2011. Results: Time series modelling using monthly unemployment rates from ABS as a predictor variable explains 69% of the variation in monthly MHED presentations across public hospitals in South Australia. Thirty-two percent of the variation in current month's male MHED presentations can be predicted by using the 2 months' prior male unemployment rate. Over 63% of the variation in monthly female MHED presentations can be predicted by either male or female prior monthly unemployment rates. Conclusions: The findings of this study highlight that even with the relatively favourable economic conditions, small shifts in monthly unemployment rates can predict variations in monthly MHED presentations, particularly for women. Monthly ABS unemployment rates may be a useful metric for predicting demand for emergency mental health services.
    Full-text · Article · Jul 2015 · BMC Emergency Medicine
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    • "One of the most studied aspects of work is the link between unemployment and numerous negative personal outcomes. Unemployment has been associated with an increase in allcause mortality (Jin et al. 1995; Roelfs et al. 2011) as well as suicide (Jin et al. 1995; Stuckler et al. 2009; Yur'yev et al. 2012). Unemployment has been found to be a major risk factor for both anxiety and depression (Herbig et al. 2013; Levecque et al. 2007) as well as increased tobacco consumption (Montgomery et al. 1998; Nandi et al. 2013), alcohol consumption, frequency of binge drinking (Claussen 1999; Henkel 2011; Montgomery et al. 1998), and alcohol dependence and abuse (Herbig et al. 2013). "
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    ABSTRACT: Previous research mostly defines the benefits of work as the absence ofunemployment’s negative outcomes or as benefits to employers, such as increased pro-ductivity. This study uses mixed methods to investigate the ways that work can enhancethe well-being of the worker. Two hundred and two participants from a rural area par-ticipated in semi-structured qualitative interviews and quantitative surveys. Participants’qualitative discussions of work in the interviews were coded with grounded theory. Themajority (74.8 %) of participants mentioned work at least once during the interview, whichfocused on prominent moments in their life stories, and 53.3 % of work mentions werepositive. Two main themes encompassing the protective benefits of work arose: self-oriented benefits and other-oriented benefits. Each main theme was further divided intothree subthemes. Self-oriented subthemes were autonomy, personal development, andempowerment; other-oriented subthemes were providing for dependents, generativity, andhelping others. Participants spoke about how each of these benefits enhances their well-being and happiness. The empowerment subtheme was positively correlated with work-place integration and negatively correlated with financial strain. This study uncoveredprotective benefits of work that have not been addressed by previous scholarship. Quali-tative data provided the flexibility to explore work-related domains for which quantitativescales do not currently exist. Work is one of the main activities of most adults, and thestudy of the psychological benefits of work can improve our understanding of adult well-being and happiness. Working for Well-Being: Uncovering the Protective Benefits of Work Through Mixed Methods Analysis. Available from: [accessed Jan 14, 2016].
    Full-text · Article · Jan 2015 · Journal of Happiness Studies
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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.
    Full-text · Article · Sep 2014 · Journal of Business and Psychology
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