Elsevier

Social Science & Medicine

Volume 144, November 2015, Pages 104-111
Social Science & Medicine

Does disability status modify the association between psychosocial job quality and mental health? A longitudinal fixed-effects analysis

https://doi.org/10.1016/j.socscimed.2015.09.024Get rights and content

Highlights

  • The relationship between psychosocial job quality and mental health differs for those people with versus without a disability.

  • People with a disability experience declines in mental health when they leave work and when working in a poor quality job.

  • Among those without a disability, a poor quality job was associated with the biggest reduction in mental health compared to when a person was optimally employed.

  • Efforts to improve psychosocial job quality will have significant mental health benefits for people with disabilities.

Abstract

Background

People with disabilities have difficulties in obtaining work. However, evidence suggests that those with disabilities derive substantial mental health benefits from employment. This paper assesses how the relationship between work and mental health is influenced by psychosocial job quality for people working with a disability.

Methods

The study design was a longitudinal cohort with 13 annual waves of data collection, yielding a sample of 122,883 observations from 21,848 people. Fixed-effects within-person regression was used to control for time invariant confounding. The Mental Component Summary (MCS) of the Short Form 36 (SF-36) measure was used as the primary outcome measure. The main exposure was a six-category measure of psychosocial job quality and employment status (including ‘not in the labour force’ [NILF] and unemployment). Disability status (‘no waves of disability reported’ and ‘all contributed waves with reported disability’) was assessed as an effect modifier. We also conducted a secondary analysis on respondents contributing both disability and non-disability waves.

Results

For those with no disability, the greatest difference in mental health (compared to optimal employment) occurs when people have the poorest quality jobs (−2.12, 95% CI −2.48, −1.75, p < 0.001). The relative difference in mental health was less in relation to NILF and unemployment (−0.39 and −0.66 respectively). For those with consistent disability, the difference in mental health when employed in an optimal job was similar between the poorest quality jobs (−2.25, 95% CI −3.84, −0.65, p = 0.006), NILF (−2.84, 95% CI −4.49, −1.20, p = 0.001) or unemployment (−2.56, 95% CI −4.32, −0.80, p = 0.004). These results were confirmed by the secondary analysis.

Conclusions

Efforts to improve psychosocial job quality may have significant mental health benefits for people with disabilities. This will contribute to the economic viability of disability employment insurance schemes in Australia and other high-income countries.

Section snippets

Background

In Australia, approximately 2.2 million (14.4%) of working-age people (14–64 years) have a disability (defined as long-term health conditions, impairments or disabilities that restricts everyday activities), with just over 50% of these people being women. Nearly half (47.3%) of people with disabilities were not in the labour force in 2015, meaning they were neither employed nor actively looking for work, compared to 17.5% of people without a disability (ABS, 2015, OECD, 2009). The low labour

Data source

The Household, Income and Labour Dynamics in Australia (HILDA) survey is a longitudinal, nationally representative study of Australian households established in 2001. It collects detailed information annually from over 13,000 individuals within over 7000 households (Wilkins, 2013). The response rate to wave 1 was 66% (Wilkins, 2013). The survey covers a range of dimensions including social, demographic, health and economic conditions using a combination of face-to-face interviews with trained

Describing the sample

Table 1 shows characteristics of the sample over the 13 waves of data. The largest group is “non-disability” with 12,383 people (60,152 observations, 49% obs), followed by intermittent disability group with 7473 (55,317 observations, 45% obs). There were 1992 people (7414 observations, 6% obs) with consistent disability There were slightly more females in the entire sample. Those who had never had a disability were on average 10 years younger than those with consistent disability. Mental health

Discussion and conclusions

This study demonstrates considerable differences in the association between psychosocial job quality and mental health depending on reported disability status. For people without a disability, the poorest psychosocial quality jobs were associated with the poorest mental health relative to optimal working conditions. By comparison, for those with a disability, poor psychosocial quality jobs, unemployment and NILF were similarly associated with poor mental health relative to optimal psychosocial

Acknowledgments

This paper uses unit record data from the Household, Income and Labour Dynamics in Australia HILDA) Survey. The HILDA Project was initiated and is funded by the Australian Government Department of Social Services DSS) and is managed by the Melbourne Institute of Applied Economic and Social Research Melbourne Institute). The findings and views reported in this paper, however, are those of the author and should not be attributed to either DSS or the Melbourne Institute. The data used in this

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