Employment trajectories and mental health-related disability in Belgium.

OBJECTIVES: An individual's quality of employment over time has been highlighted as a potential determinant of mental health. With mental ill-health greatly contributing to work incapacities and disabilities in Belgium, the present study aims to explore whether mental health, as indicated by registered mental health-related disability, is structured along the lines of employment quality, whereby employment quality is assessed over time as part of individuals' labour market trajectories. METHODS: Using administrative data from the Belgian Crossroads Bank for Social Security over 16 quarters between 2006 and 2009, transitions between waged jobs of varying quality (based on dimensions of income, working time, employment stability and multiple jobholding), self-employment, and unemployment are considered among individuals in the labour force aged 30-40 at baseline (n = 41,065 women and 45,667 men). With Multichannel Sequence Analysis and clustering, we constructed ideal types of employment trajectories. Fitting Cox regressions, we then evaluated individuals' hazard of experiencing a disability from a mental disorder between 2010 and 2016. RESULTS: Our analysis highlights various gender-specific trajectories. Among both genders, individuals exposed to near-constant unemployment over the initial 4 years showed the highest hazard of subsequent mental health-related disability compared to a group characterised by stable full-time employment, single jobholding, and above-median income. Trajectories involving a higher probability of subsidised and non-standard employment and (potential) spells of unemployment and lower relative income were also strong predictors of cause-specific disabilities. Health selection and confounding might, however, be contributing factors. CONCLUSIONS: Our study shows a gradient of mental disorders resulting in a disability along trajectory types. Our findings highlight the predictive power of labour market trajectories and their employment quality for subsequent mental disorder-related disability. Future research should examine the mechanisms, including selection effects in this association.

Design and development of a digital intervention for workplace stress and mental health (EMPOWER).

Purpose: We describe the design and development of the European Platform to Promote health and wellbeing in the workplace (EMPOWER) digital intervention that provides an integrative user programme meeting the needs of employees and employers in addressing work stress. Results: A user-centred design process was followed from January 2020 until November 2021. A tailored algorithm was developed to provide support at the individual employee level and the company level. Each element of the digital intervention was developed in English and then translated in Spanish, English, Polish and Finnish. The digital intervention consists of a website and a mobile application (app) that provides algorithm-based personalised content after assessing a user's somatic and psychological symptoms, work functioning, and psychosocial risk factors for work stress. It has a public section and an employer portal that provides recommendations to reduce psychosocial risks in their company based upon clustered input from employees. Usability testing was conducted and showed high ease of use and completion of tasks by participants. Conclusion: The EMPOWER digital intervention is a tailored multimodal intervention addressing wellbeing, work stress, mental and physical health problems, and work productivity. This will be used in a planned RCT in four countries to evaluate its effectiveness.

Study protocol of EMPOWER: A cluster randomized trial of a multimodal eHealth intervention for promoting mental health in the workplace following a stepped wedge trial design.

Objective: This article describes the EMPOWER study, a controlled trial aiming to determine the effectiveness and cost-effectiveness of an eHealth intervention to prevent common health problems and reduce presenteeism and absenteeism in the workplace. Intervention: The EMPOWER intervention spans universal, secondary and tertiary prevention and consists of an eHealth platform delivered via a website and a smartphone app designed to guide employees throughout different modules according to their specific profiles. Design: A stepped-wedge cluster randomized trial will be implemented in four countries (Finland, Poland, Spain and UK) with employees from small and medium enterprises (SMEs) and public agencies. Companies will be randomly allocated in one of three groups with different times at which the intervention is implemented. The intervention will last 7 weeks. Employees will answer several questionnaires at baseline, pre- and post-intervention and follow-up. Outcome measures: The main outcome is presenteeism. Secondary outcomes include depression, anxiety, insomnia, stress levels, wellbeing and absenteeism. Analyses will be conducted at the individual level using the intention-to-treat approach and mixed models. Additional analyses will evaluate the intervention effects according to gender, country or type of company. Cost-effectiveness and cost-utility analyses [based on the use of quality-adjusted life-years (QALYS)] will consider a societal, employers' and employees' perspective.

Is any job better than no job at all? Studying the relations between employment types, unemployment and subjective health in Belgium.

BACKGROUND: This study focuses on the health impact of the labour market position, since recent research indicates that exposure to both unemployment and precarious employment causes serious harm to people's health and well-being. An overview of general and mental health associations of different labour market positions in Belgium is provided. A distinction is made between employment and unemployment and in addition between different types of jobs among the employed, taking into account the quality of employment. Given the fact that precarious labour market positions tend to coincide with a precarious social environment, the latter is taken into consideration by including the composition and material living conditions of the household and the presence of social support. METHODS: Belgian data from the 1st Generations and Gender Survey are used. A Latent Class Cluster Analysis is performed to construct a typology of labour market positions that includes four different types of waged employment: standard jobs, instrumental jobs, precarious jobs and portfolio jobs, as well as self-employment and unemployment. Then, binary logistic regression analyses are performed in order to relate this typology to health, controlling for household situation and social support. Two health outcomes are included: self-perceived general health (good versus fair/bad) and self-rated mental health (good versus bad, based on 7 items from the Center for Epidemiologic Studies Depression Scale). RESULTS: Two labour market positions are consistently related to poor general and mental health in Belgium: unemployment and the precarious job type. The rather small gap in general and mental health between both labour market positions emphasises the importance of employment quality for the health and well-being of individuals in waged employment. Controlling for the household level context and social support illustrates that part of the reported health associations can be explained by the precarious social environment of individuals in unfavourable labour market positions. CONCLUSIONS: The results from this study confirm that the labour market position and social environment of individuals are important health determinants in Belgium.

Precarious Employment and Quality of Employment in Relation to Health and Well-being in Europe.

This article presents an overview of the recent work on precarious employment and employment quality in relation to workers' health and well-being. More specifically, the article mainly reviews the work performed in the E.U. 7th Framework project, SOPHIE. First, we present our overarching conceptual framework. Then, we provide a compiled overview of the evidence on the sociodemographic and European cross-country distribution of employment quality and employment precariousness. Subsequently, we provide the current evidence regarding the relations with health and broader worker well-being indicators. A final section summarizes current insights on the pathways relating precarious employment and health and well-being. The article concludes with a plea for further data collection and research into the longitudinal effects of employment precariousness among emerging groups of workers. Based on the evidence compiled in this article, policymakers should be convinced of the harmful health and well-being effects of employment precariousness and (further) labor market flexibilization.

How does employment quality relate to health and job satisfaction in Europe? A typological approach.

The changing nature of employment in recent decades, due to an increased emphasis on flexibility and competitiveness in European labour markets, compels the need to assess the consequences of contemporary employment situations for workers. This article aims to study the relation between the quality of employment and the health and well-being of European workers, using data from the 2010 European Working Conditions Survey. A typology of employment arrangements, mapping out employment quality in the European labour force, is constructed by means of a Latent Class Cluster Analysis. This innovative approach shows that it is possible to condense multiple factors characterising the employment situation into five job types: Standard Employment Relationship-like (SER-like), instrumental, precarious unsustainable, precarious intensive and portfolio jobs. Binary logistic regression analyses show that, controlling for other work quality characteristics, this employment quality typology is related to self-perceived job satisfaction, general health and mental health. Precarious intensive jobs are associated with the worst and SER-like jobs with the best health and well-being situation. The findings presented in this study indicate that, among European wage workers, flexible and de-standardised employment tends to be related to lower job satisfaction, general health and mental health. The quality of employment is thus identified as an important social determinant of health (inequalities) in Europe.