What is the impact of job precariousness on depression? Risk assessment and attributable fraction in Spain.

OBJECTIVES: The prevalence of depression related to precarious employment (PE) has become a significant public health concern, given the declining trend of the standard employment relationship. Research has focused on the mental health detrimental effects of employment conditions, whereas there is scarce evidence concerning the burden of depression that could be prevented by targeting precariousness. This paper estimates the impact of PE on the risk of depression and the attributable fraction within the active and working salaried population in Spain. STUDY DESIGN: Observational cross-sectional on data drawn from the Spanish portion of European Health Survey 2020. METHODS: After applying selection criteria and descriptives, binary logistic regression models stratified by sex are used to examine the associations between a 9-categories combination of employment precariousness and occupational social class, and depressive symptoms. RESULTS: There is a higher risk of depression among individuals in PE and among those who are unemployed, with a notable gradient based on occupational social class for women. Adjusting by sex, age and foreign-born origin, we estimate that approximately 15.0% (95% confidence interval [CI]: 1.0%-26.2%) of depression cases among the working population and 33.3% (95% CI: 23.2%-43.2) among the active population can be attributed to PE. CONCLUSIONS: These findings highlight the public health impact of PE on mental health, provide evidence to estimate the economic burden linked to employment-related mental health, and underscore the need for policy changes and interventions at the level of labour markets and workplaces to mitigate the detrimental effects of PE.

Retrenched Welfare Regimes Still Lessen Social Class Inequalities in Health: A Longitudinal Analysis of the 2003-2010 EU-SILC in 23 European Countries.

This article builds on recent work that has explored how welfare regimes moderate social class inequalities in health. It extends research to date by using longitudinal data from the EU-SILC (2003-2010) and examines how the relationship between social class and self-reported health and chronic conditions varies across 23 countries, which are split into five welfare regimes (Nordic, Anglo-Saxon, Eastern, Southern, and Continental). Our analysis finds that health across all classes was only worse in Eastern Europe (compared with the Nordic countries). In contrast, we find evidence that the social class gradient in both measures of health was significantly wider in the Anglo-Saxon and Southern regimes. We suggest that this evidence supports the notion that welfare regimes continue to explain differences in health according to social class location. We therefore argue that although downward pressures from globalization and neoliberalism have blurred welfare regime typologies, the Nordic model may continue to have an important mediating effect on class-based inequalities in health.

The impact of social conditions on patient adherence to pulmonary tuberculosis treatment.

SETTING: Tuberculosis (TB) remains one of the main concerns in global health. One of the main threats to treatment success is patient non-adherence to anti-tuberculosis treatment. OBJECTIVE: To identify the relation between social conditions and treatment adherence in a prospective cohort setting in an intermediate TB burden country. DESIGN: To identify associations between poor adherence and social conditions, including educational level, type of residence and occupation, we constructed hierarchical logistic regression models. RESULTS: A total of 551 participants were included in the study. Low educational levels, poor housing and occupations in the construction and manufacturing industries and service sectors were associated with poor adherence; this association was likely to be differentiated by previous history of anti-tuberculosis treatment. CONCLUSION: Policy making should focus on improving the social conditions of patients by working towards better housing conditions and providing health promoting working conditions to enable treatment adherence.

What should we know about precarious employment and health in 2025? Framing the agenda for the next decade of research.

The generalization of flexible labour markets, the declining influence of unions and the degradation of social protection has led to the emergence of new forms of employment at the expense of the Standard Employment Relationship, as well as a considerable amount of research across social and scientific disciplines. Years ago we suggested the urgent need to disentangle the consequences of new types of employment for the health and well-being of workers, contending that the study of precarious employment and health is in its infancy. Today, research challenges include clearer, more precise definitions of the original concepts, a more detailed understanding of the pathways and mechanisms through which precarious employment harms worker health, stronger information systems for monitoring the problem and a complex systems approach to employment conditions and health research. All of these must be guided by the theoretical and policy debates linking precarious employment and health, and be geared towards developing better tools for the design, implementation and evaluation of policies intended to minimize precariousness in the labour market and its effects on public health and health inequalities. Our aim in this paper is to outline an agenda for the next decade of research on precarious employment and health, establishing a compelling programme that expands our understanding of complex causes and links.

Motivations of nurses who migrate to Canada as domestic workers.

BACKGROUND: While some trained nurses migrate to destination countries to work as domestic workers, little is known about their migration motivations. AIM: This study explores the motivations of Philippine educated nurses who migrated to Canada through the Live-in Caregiver Program from 2001 to 2011 (a Canadian domestic worker programme). METHODS: A single case study qualitative methodology and the transnational feminist concept of global care chains were utilized for this study. Interviews of 15 Philippine educated nurses who migrated to Canada as domestic workers were conducted in the province of Ontario, Canada, between February to October 2012. All participants had a baccalaureate degree from the Philippines. Interviews were tape recorded, transcribed verbatim and analysed using critical discourse analysis, aided by NVIVO 10 data analysis software. RESULTS: Findings reveal a multi-step immigration process in which nurses migrate from the Philippines to the Middle East (especially Saudi Arabia) and finally to Canada. While emigration from the Philippines is mainly economically driven, migration from the Middle East to Canada is primarily motivated by the desire for Canadian citizenship for the family. Also, perceived social status and lifestyle in Canada as compared to the Middle East motivates this group of women to migrate to Canada. LIMITATION: The major limitation of this study is the lack of input from nursing policy makers. CONCLUSION: Gender-based familial ideologies and perspective on social status influence the migration decision of this group of nurses. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Implications for nursing and health policy makers include the provision of clear pre-migration information (including on the nursing registration process) to internationally educated nurses, advocacy for stronger immigration policies to ensure the integration of internationally educated nurses and a consideration of gender in all health human resource policies.

Precarious employment: understanding an emerging social determinant of health.

Employment precariousness is a social determinant that affects the health of workers, families, and communities. Its recent popularity has been spearheaded by three main developments: the surge in "flexible employment" and its associated erosion of workers' employment and working conditions since the mid-1970s; the growing interest in social determinants of health, including employment conditions; and the availability of new data and information systems. This article identifies the historical, economic, and political factors that link precarious employment to health and health equity; reviews concepts, models, instruments, and findings on precarious employment and health inequalities; summarizes the strengths and weaknesses of this literature; and highlights substantive and methodological challenges that need to be addressed. We identify two crucial future aims: to provide a compelling research program that expands our understanding of employment precariousness and to develop and evaluate policy programs that effectively put an end to its health-related impacts.

Depression, social factors, and farmworker health care utilization.

PURPOSE: Farmworkers frequently live in rural areas and experience high rates of depressive symptoms. This study examines the association between elevated depressive symptoms and health care utilization among Latino farmworkers. METHODS: Data were obtained from 2,905 Latino farmworkers interviewed for the National Agricultural Workers Survey. Elevated depressive symptoms were measured using the Center for Epidemiologic Studies Depression short-form. A dichotomous health care utilization variable was constructed from self-reported use of health care services in the United States. A categorical measure of provider type was constructed for those reporting use of health care. RESULTS: Over 50% of farmworkers reported at least 1 health care visit in the United States during the past 2 years; most visits occurred in a private practice. The odds of reporting health care utilization in the United States were 45% higher among farmworkers with elevated depressive symptoms. Type of provider was not associated with depressive symptoms. Women were more likely to seek health care; education and family relationships were associated with health care utilization. CONCLUSIONS: Latino farmworkers who live and work in rural areas seek care from private practices or migrant/Community Health Clinics. Farmworkers with elevated depressive symptoms are more likely to access health care. Rural health care providers need to be prepared to recognize, screen, and treat mental health problems among Latino farmworkers. Outreach focused on protecting farmworker mental health may be useful in reducing health care utilization while improving farmworker quality of life.

Hospital admissions of young persons for illicit drug use or abuse: does neighborhood of residence matter?

Adolescence constitutes a period of risk for drug use and drug use disorders. Previous research, largely focused on individual risk factors, has failed to include neighborhood structure in the study of determinants of youth drug use or abuse. A cohort of 76,693 adolescents ages 13-15 from 586 urban neighborhoods in Sweden were followed up for 12 years, from age 16 to age 28. Multilevel modeling was used to analyze neighborhood variations in hospital admissions due to illicit drug use or abuse. We found a variation of 8% by neighborhood economic status and the risk of being admitted to hospital increased 73% in low-compared to high-income neighborhoods. Our results suggest that neighborhood of residence in adolescence plays a significant role in predicting future health-related behaviors and that the need for drug abuse interventions at a neighborhood level is compelling.

Mental health research with Latino farmworkers: a systematic evaluation of the short CES-D.

Mental health research among Latino farmworkers is hampered by the absence of measurement evaluation that ensures farmworkers understand and can consistently and appropriately respond to questions about mental health. Cross-sectional data were obtained from 409 farmworkers via interviewer-administered survey questionnaires. Mental health was operationalized with the short-form Center for Epidemiologic Studies, Depression (CES-D) scale. The structured interviewer-administered survey questionnaires included measures to capture personal and work-related factors that could affect farmworkers' ability to understand and respond to mental health questions probed by the CES-D. Good variability in item response was observed across the 10 short-form CES-D items. There was no evidence of differential response across sub-groups of farmworkers for six of the 10 items. Responses to four of the 10 items differed by educational attainment, country of origin, and language preference. Overall, the internal consistency of the 10 items exceeded standard conventions, and observed differences in depressive symptoms were as expected. Researchers in farmworker mental health must remain attentive to the strength and validity of available measures for migrants, different ethnic groups and different socioeconomic backgrounds. Nevertheless, the overall pattern suggests that the CES-D is a viable tool for advancing farmworker mental health research.

A multi-group cross-lagged analyses of work stressors and health using Canadian National sample.

This article examines the reciprocal relationships between work variables and health outcomes and if these relationships differ by social class (measured by occupational grouping). We used longitudinal data from the 1994/95--2002/03 Canadian National Population Health Survey (NPHS). Karasek's work stress variables were measured in the 1994/95 (cycle 1, time 1), 2000/01 (cycle 4, time 2) and 2002/03 (cycle 5, time 3) surveys. Analyses were limited to 2556 respondents aged 18-56 at time 1 and who remained in the same social class (as defined by occupational position) for all the three time points. Work variables used were job strain ratio, work social support and job insecurity. Health outcomes used were distress, depression and self-rated health. Multi-group path analyses were used to investigate the reciprocal relationships between work and health variables and if these relationships differed by social class. Analyses controlled for age, gender, marital status and work status. We find there is a differential burden of work psychosocial factors and health outcomes by social class. The cross-lagged relationships between work and health depended on the outcome, social class and time lag. More significant paths from work to health were observed than reverse paths from health to work. More significant relationships between work and health were observed for the shorter time lag (2 years) compared to longer time lags (6 years). Low work social support and job insecurity were more detrimental to health for respondents in lower social class positions. Findings from this study highlight the importance of time lag, and to some extent social class, in the reciprocal relationships between work and health.

Immigration and self-reported health status by social class and gender: the importance of material deprivation, work organisation and household labour.

OBJECTIVE: Spain and Catalonia have experienced several immigration waves over the last century. The goal of this study was to examine the role of social class and its mediating pathways (ie, work organisation, material deprivation at home and household labour) in the association between migration status and health, as well as whether these associations were modified by social class or gender. SETTING: Barcelona city, Spain. DESIGN AND PARTICIPANTS: The study used the Barcelona Health Interview Survey, a cross-sectional survey of 10,000 residents of the city's non-institutionalised population in 2000. The present study was conducted on the working population, aged 16-64 years (2342 men and 1872 women). The dependent variable was self-reported health status. The main independent variable was migration status. Other variables were: social class (measured using Erik Olin Wright's indicators); age; psychosocial and physical working conditions; job insecurity; type of labour contract; number of hours worked per week; material deprivation at home and household labour. Two hierarchical logistic regression models were built by adding different independent variables. RESULTS: Among men, foreigners presented the poorest health status (fully adjusted odds ratios (OR) 2.16; 95% CI 1.14 to 4.10), whereas among women the poorest health status corresponded to those born in other regions of Spain. There was an interaction between migration and social class among women, with women owners, managers, supervisors or professionals born in other regions of Spain reporting a worse health status than the remaining groups (fully adjusted OR 3.60; 95% CI 1.83 to 7.07). CONCLUSION: This study has shown that the pattern of perceived health status among immigrant populations varies according to gender and social class. These results have to be taken into account when developing policies addressed at the immigrant population.

Trends in socioeconomic mortality inequalities in a southern European urban setting at the turn of the 21st century.

OBJECTIVE: To analyse trends in mortality inequalities by educational level for main causes of death among men and women in Barcelona, Spain, at the turn of the 21st century (1992-2003). METHODS: The population of reference was all Barcelona residents older than 19 years. All deaths between 1992-2003 were included. Educational level was obtained through record linkage between the mortality register and the municipal census of Barcelona city. Variables studied were age, sex, educational level, period of death (four periods of 3 years) and cause of death. Age-standardised mortality rates for each educational level, sex and period were calculated. Poisson regression models were fitted to obtain relative index of inequality (RII) for educational level, adjusted for age for the time-periods. RESULTS: RII for all causes of death was constant (around 1.5), but rate differences were higher in 1995-7 (715.6 per 100,000 in men and 352.8 in women) than in other periods and tended to decrease in men over the periods. Analysis of inequality trends by specific causes of death shows a stable trend for the majority of causes, with higher mortality among those with less education for all causes of death except lung cancer and breast cancer among women having RII below 1. CONCLUSIONS: Relative inequalities in total mortality by sex in Barcelona did not change during the 12 years studied, whereas absolute inequalities tended to decrease in men. Our study fills an important gap in southern Europe and Spanish literature on trends during this period.

Associations between temporary employment and occupational injury: what are the mechanisms?

OBJECTIVE: To determine whether observed higher risks of occupational injury among temporary workers are due to exposure to hazardous working conditions and/or to lack of job experience level. METHODS: Data systematically recorded for 2000 and 2001 by the Spanish Ministry of Labour and Social Affairs on fatal and non-fatal traumatic occupational injuries were examined by type of employment and type of accident, while adjusting for gender, age, occupation, and length of employment in the company. In the study period there were 1500 fatal and 1 806 532 non-fatal traumatic occupational injuries that occurred at the workplace. Incidence rates and rate ratios (RR) were estimated using Poisson regression models. RESULTS: Temporary workers showed a rate ratio of 2.94 for non-fatal occupational injuries (95% CI 2.40 to 3.61) and 2.54 for fatal occupational injuries (95% CI 1.88 to 3.42). When these associations were adjusted by gender, age, occupation, and especially length of employment, they loose statistic significance: 1.05 (95% CI 0.97 to 1.12) for non-fatal and 1.07 (95% CI 0.91 to 1.26) for fatal. CONCLUSIONS: Lower job experience and knowledge of workplace hazards, measured by length of employment, is a possible mechanism to explain the consistent association between temporary workers and occupational injury. The role of working conditions associated with temporary jobs should be assessed more specifically.

Qualitative and quantitative research in social epidemiology: is complementarity the only issue?

Although in recent years there has been a growing acceptance of qualitative research in social epidemiology, the role and scope of its use remain a contested terrain. We sketch some of the issues that have been the focus of the debate between supporters and critics of qualitative research in social epidemiology and adjacent public health disciplines. They include epistemological problems, such as the limitations of survey research to uncover social mechanisms, lack of background among epidemiologists to generate sound hypotheses for specific populations, and ontological problems such the idealism inherent in some of the qualitative research coming from anthropology. Next we review the urban ethnographies of Elliot Liebow's and a decade of population based research in African American and low income neighborhoods in the United States to expose another role for qualitative research in social epidemiology. Thus, we argue that qualitative research has been used in scientific debates that confront egalitarian researchers with institutions or peers with opposing economic interests and ideologies. Qualitative research is often a powerful tool to fuel alternative theoretical frameworks and measures to be included in quantitative population based surveys. We confine this use of qualitative research to the academic world and do not necessarily imply that communities benefit from it as in action research.