Long-term trends in psychosocial working conditions in Europe-the role of labor market policies.

BACKGROUND: Employees have witnessed rising trend in work stress over the last few decades. However, we know a little about country differences in those trends. Our article fills this gap in the literature by examining heterogeneities in trends in working conditions by country groups defined by their amount of investment into labor market policy (LMP) programs. Additionally, we provide findings on differences in occupational inequalities between country groups. METHODS: We use comparative longitudinal data of the European Working Conditions Surveys including cross-sectional information on employees from 15 countries surveyed in Waves 1995, 2000, 2005, 2010 and 2015. Estimation results are provided by three-way multilevel models with employees nested within country-years nested within countries. Our work stress measure is the proxy version of job strain based on the demand-control model. RESULTS: Our regression results indicate that for employees in countries with the least LMP spending job strain increased by 10% from 1995 to 2015 compared to a smaller and insignificant change in middle- and high-LMP countries. In low-LMP countries, inequalities in job strain also widened during the studied period: the gap in job strain between the highest- and lowest-skilled increased by 60% from 1995 to 2015. This contrasts a stable gap in middle- and high-LMP countries. CONCLUSIONS: Our results direct the attention to the vulnerable position of the least skilled and highlight that LMP investments may buffer some of the adverse impacts of globalization and technological changes and effectively improve the labor market situation of the least skilled.

Facilitating stress prevention in micro and small-sized enterprises: protocol for a mixed method study to evaluate the effectiveness and implementation process of targeted web-based interventions.

BACKGROUND: Workplace-related stress is a major risk factor for mental and physical health problems and related sickness absence and productivity loss. Despite evidence regarding the effectiveness of different workplace-based interventions, the implementation of stress prevention interventions is rare, especially in micro and small-sized enterprises (MSE) with fewer than 50 employees. The joint research project "PragmatiKK"+ aims to identify and address the specific barriers to the implementation of stress prevention interventions in MSE. This study protocol describes a mixed method study design to evaluate the effectiveness of adapted stress prevention interventions and the implementation process via an integrated web-based platform ("System P") specifically targeted at MSE. METHODS: First, we develop a web-based intervention, which accounts for the specific working conditions in MSE and addresses stress prevention at a structural and behavioral level. Second, we use common methods of implementation research to perform an effect and process evaluation. We analyze the effectiveness of the web-based stress prevention interventions by comparing depressive symptoms at baseline and follow-up (after 6 months and 12 months). Indicators for a successful implementation process include acceptability, adoption, feasibility, reach, dose, and fidelity, which we will measure with quantitative web-based questionnaires and qualitative interviews. We will also analyze the accumulated usage data from the web-based platform. DISCUSSION: Collecting data on the implementation process and the effectiveness of a web-based intervention will help to identify and overcome common barriers to stress prevention in MSE. This can improve the mental health of employees in MSE, which constitute more than 90% of all enterprises in Germany. + Full Project Name: "PragmatiKK - Pragmatische Lösungen für die Implementation von Maßnahmen zur Stressprävention in Kleinst- und Kleinbetrieben "(= Pragmatic solutions for the implementation of stress prevention interventions in micro and small-sized enterprises). TRIAL REGISTRATION: German Register of Clinical Studies (DRKS): DRKS00026154 , date of registration: 2021-09-16.

[Do digital technologies at work impact mental health of employees?] / Haben digitale Technologien bei der Arbeit Einfluss auf die psychische Gesundheit?

BACKGROUND: Traditional work stress research identified a large number of stressors; however, technology as a source of stress was not the focus of interest for long time. OBJECTIVE: This article describes the concept of technostress and investigates the impact of digital technologies at work on mental health. MATERIAL AND METHODS: Narrative review. Conceptualization of technostress, potential mechanisms of action and summary of empirical results on the influence on mental health. RESULTS: Several domains of technostress have been defined so far. Although empirical studies are rare and subject to methodological limitations, results suggest that certain types of technostress at work may have an adverse effect on mental health. Notably, digital technologies may also have a positive impact on the psychological well-being of employees if, for example, they enable better work organization. CONCLUSION: The digitalization of work is related to specific risks for the mental health of employees but also to possible benefits. Implications for further research in this developing field are identified.

[Social inequalities in the regional spread of SARS-CoV-2 infections]. / Soziale Ungleichheit in der regionalen Ausbreitung von SARS-CoV-2.

BACKGROUND AND OBJECTIVE: It has not been adequately answered whether the spread of SARS-CoV­2 is influenced by social and economic factors. Earlier studies generally looked at cumulative incidences up to the analysis date and did not take into account the development of the spread over time. This study therefore focuses on the regional dynamic of new infections and their relationship to socioeconomic factors. Based on the literature we describe the state of knowledge and present our own analyses of administrative data from Germany. METHODS: For this study, we examined regional progress data of reported COVID-19 cases for 401 cities and counties in Germany and associated them with socioeconomic characteristics of the areas. Age-standardized weekly incidence rates were calculated for the period from 3 February 2020 to 28 March 2021. Macroindicators were added from the INKAR database (e.g., income, employment rate, and crowding). RESULTS: While areas with higher incomes and lower poverty had higher incidences in the first and at the beginning of the second wave of the pandemic, they increased significantly in low-income regions from December 2020 on. Regions with a high proportion of gainfully employed people in general and especially those in the manufacturing sector had high incidences, especially in the second wave and at the beginning of the third wave. A low mean living space per inhabitant was related to higher incidence rates since November 2020. CONCLUSION: The regional temporal course of the pandemic correlates with social and economic indicators. A differentiated consideration of these differences could provide information on target group-specific protection and test strategies and help to identify social factors that generally favor infections. An English full-text version of this article is available at SpringerLink as Supplementary Information.

Better air but not for all? Changes in second-hand smoke exposure at workplaces in 29 European countries over 10 years.

BACKGROUND: As the largest study of its kind to date, this article aims to describe the scope, trends over time, socio-demographic risk groups and the association with different progressive regulations relating to workplace second-hand smoke (SHS) exposure in 29 European countries during a period of high regulatory action. METHODS: Three waves of the European Working Conditions Surveys (2005, 2010 and 2015) were evaluated, including a total of 95 718 workers. The samples are representative for all employed residents of the 29 countries included. All interviews were conducted face-to-face at respondents' homes (computer-assisted personal interviews). SHS exposure among the overall working population of 29 countries-including smokers-was examined. Workplace regimes were grouped corresponding to the sub-scale 'workplace' as used in the Tobacco Control Scale. RESULTS: Between 2005 and 2015, SHS exposure in the European countries declined from around 19.0% (95% CI 16.1-22.0) to 9.9% (8.3-11.5). High SHS-exposure was reported by workers with the lowest level of education [11.5% (9.7-13.2)], among high-skilled manual labourers [14.3% (12.1-16.4)] and among those without a standard employment contract [11.2% (9.3-13.1)]. The highest exposure was reported by workers in the food service industry [19.7% (16.8-22.6)]. Countries with less workplace-related smoking prevention regulations were found to have the highest overall levels of exposure. CONCLUSION: This multinational series of cross-sectional surveys on the trends in passive smoking in the workplace have shown that countries with more comprehensive workplace smoking bans overall report lower levels of SHS exposure among their work force as compared with slow progressing countries.

The role of pension contributions in explaining inequalities in depressive symptoms. Results from SHARE.

Aims: Research has established solid evidence that socioeconomic position impacts health. It is, however, still debated to what extent characteristics of entire employment histories are associated with health inequalities later on. This study investigates associations between contributing to pension schemes throughout entire employment histories and depressive symptoms in older men and women. Methods: We use retrospective life history data from the Survey of Health, Ageing and Retirement in Europe (SHARE), collected in 2008-2009 from retired men and women. Data include detailed information on previous employment histories (between age 25 and 60 years) that allows us to measure labour market involvements and pension contributions during past working lives. In addition, we measure elevated depressive symptoms using EURO-D. Results: We observe that employed work without contributing to pension schemes is associated with elevated depressive symptoms for women, even when taking the current household income into consideration. For men (but not for women), self-employed work without pension contributions is linked to elevated depressive symptoms. Conclusions: Our results indicate that studies linking previous employment participation to health after labour market exit should not only consider whether a person worked, but also whether he or she contributed to a pension scheme. In addition, our study points to interesting gender differences, where pension contributions matter most for women in employed work and for men in self-employed work.

Adverse Employment Histories, Later Health Functioning and National Labor Market Policies: European Findings Based on Life-History Data From SHARE and ELSA.

OBJECTIVES: We investigate associations between adverse employment histories over an extended time period and health functioning in later life, and explore whether national labor market policies moderate the association. METHODS: We use harmonized life-history data from the Gateway to Global Aging Data on two European studies (SHARE and ELSA) linked to health beyond age 50 (men = 11,621; women = 10,999). Adverse employment histories consist of precarious, discontinued, and disadvantaged careers between age 25 and 50, and we use depressive symptoms, grip strength, and verbal memory as outcomes. RESULTS: Adverse employment histories between age 25 and 50 are associated with poor health functioning later in life, particularly repeated periods of unemployment, involuntary job losses, weak labor market ties, and disadvantaged occupational positions. Associations remain consistent after adjusting for age, partnership history, education and employment situation, and after excluding those with poor health prior to or during working life. We find no variations of the associations by national labor market policies. DISCUSSION: Our study calls for increased intervention efforts to improve working conditions at early career stages. Despite the importance in shaping employment histories, the role of national policies in modifying the impact of employment on health is less clear.

Technostress at work and mental health: concepts and research results.

PURPOSE OF REVIEW: The ongoing digitalization has profound consequences for work in modern economies. It is, therefore, important to investigate if digital technologies increase stress at work (i.e. 'technostress') and lead to impaired mental health. This article describes the concept of technostress and discusses possible risks and opportunities of digital technologies at work and their effect on mental health. RECENT FINDINGS: Studies report that the use of digital technologies is associated with specific psychosocial demands (e.g. higher workload, complexity, conflicts between work and other life domains) and resulting psychobiological stress reactions. It is, however, still unclear if this kind of technostress causes mental disorders because epidemiological studies are missing. Yet, an increasing number of studies suggests that well designed digital work may promote good health if it optimizes work organization or enables greater flexibility, and increases control and autonomy at work. SUMMARY: Digitalization of work seems to have both opportunities and risks for the mental health of employees. The number of studies is currently limited and further research is necessary to describe the advantages and disadvantages more precisely.

Development and Validation of a Questionnaire to Measure Psychosocial Work Stressors in Modern Working Environments.

OBJECTIVE: The rapid development of technology is changing working conditions of many employees. With this, appropriate measurement instruments to capture work-related psychosocial risks to create healthy working conditions are becoming more and more important. Therefore, we developed and validated a questionnaire to assess stressors in work settings which are characterized by a high degree of digitization. METHOD: The validation was based on two independent studies with data collected in four subsamples. All participants were asked about their working conditions and health-related topics using online questionnaires. RESULTS: The resulting 16-item questionnaire consists of five scales: work load, boundary permeability, participation, leader support, and usability. CONCLUSIONS: The results show that the five identified stressors showed acceptable to good values with regard to reliability (internal consistencies, test-retest reliabilities, and interrater agreement) as well as (convergent and concurrent) validity.

Agreement of Self-Reported and Administrative Data on Employment Histories in a German Cohort Study: A Sequence Analysis.

Collecting life course data is increasingly common in social and epidemiological research, either through record linkage of administrative data or by collecting retrospective interview data. This paper uses data on employment histories collected through both strategies, compares the attained samples, and investigates levels of agreements of individual histories. We use data from the German Heinz Nixdorf Recall Study with information on employment histories collected retrospectively from 2011 until 2014 (N = 3059). Administrative data from the German Institute for Employment Research (IAB) were linked to the survey data. After comparing respondents who provide self-reported histories with the subsample of the ones for which administrative data were available, we investigate the agreement of individual employment histories from the two sources (between 1975 and 2010) using sequence analyses. Almost all participants provided survey data on employment histories (97% of the sample), linkage consent was given by 93%, and administrative data were available for 63% of the participants. People with survey data were more likely to be female, to have a higher education, and to work self-employed and in the tertiary sector. The agreement of individual employment histories is high and similar across time, with a median level of agreement of 89%. Slightly lower values exist for women and people working in the tertiary sector, both having more complex histories. No differences exist for health-related factors. In conclusion, it is likely that missing consent and failed record linkage lead to sample differences; yet, both strategies provide comparable and reliable life course data.

Perceived stress in human-machine interaction in modern manufacturing environments-Results of a qualitative interview study.

Rapid advances in digitization technologies are changing modern working conditions especially in industrial settings. Consequently, employees are confronted with new forms of human-machine interaction. Whether changes in working conditions in general, and the increasing relevance of human-machine interaction in particular, affect psychosocial working conditions, and employee's health is currently matter of debate, but empirical data are lacking. Therefore, we conducted semistructured interviews with 36 employees working in five different companies. The interviews were aimed at identifying potential stressors associated with the introduction and use of modern technologies in the manufacturing industry. The results show that stressors linked to human-machine interaction are technical problems, poor usability, low situation awareness, and increased requirements on employees' qualification. For example, technical problems such as breakdowns or slowdowns were described as a main stressor when employees were not qualified to handle these problems on their own, thus decelerating work flows and causing additional time pressure. Overall, the results show that problems in human-machine interaction, which have been observed in laboratory and nonindustrial settings, also apply to industrial work places with highly automated working conditions and are a potential source of stress. These factors should be considered in psychosocial risk assessment of work-related stressors.

Positive verbal feedback about task performance is related with adaptive physiological responses: An experimental study of the effort-reward imbalance stress model.

Effort-reward imbalance in the workplace has been related with poor mental and physical health and a variety of negative organisational outcomes including increased rates of absenteeism, presentism, and job turnover, but the model has rarely been assessed using experimental designs. Female participants (N = 90) were randomly assigned to positive verbal feedback and no verbal feedback conditions. Within a simulated office environment, all participants were under time-pressure to successfully complete computer-based tasks in order to gain remuneration. Positive verbal feedback about task performance was provided to improve the aspect of 'esteem reward' (while keeping effort constant) using a mixed within-between subjects design. Psychological, behavioural (task performance), and physiological (heart rate variability, salivary alpha amylase) measures assessed the impact of the positive verbal feedback. Participants receiving the esteem manipulation did not self-report increased rewards, but performed moderately better on the task, and had more adaptive physiological reactivity in the high reward versus the standard condition. Similar to recent research our findings highlight the importance of concurrent assessments of both self-reports and physiological measures of stress, and suggest that positive verbal feedback about work performance can elicit adaptive physiological responses and may also positively influence task efficacy.

Do resources buffer the prospective association of psychosocial work stress with depression? Longitudinal evidence from ageing workers.

Objectives There is now convincing evidence that psychosocial work stressors are linked to depression. Few studies, however, have tested if individual resources can buffer the longitudinal effects of psychosocial work stressors on depressive symptoms. This study investigates how two types of resources (internal and external resources) affect the association between psychosocial work stressors and depressive symptoms. Methods Data were obtained from the US Health and Retirement Study, with baseline information on psychosocial work stressors [job strain and effort-reward imbalance (ERI)] and on internal ("high mastery" and "low constraints") and external resources ("private social support") among initially healthy workers. This information was linked to elevated depressive symptoms two years later. The sample includes 5473 observations and we report relative risks (RR) and effect modification on the additive and multiplicative scale. Results Psychosocial stressors and low resources (internal and external) were both independently related to depressive symptoms. Individuals with both, psychosocial stressors and low resources, had the highest risk of developing elevated depressive symptoms (eg, RR ERI-LowMastery3.32, 95% CI 2.49-4.42; RR JobStrain-LowMastery2.89, 95% CI 2.18-3.84). Yet, based on interaction analyses, only social support from friends buffered the association between work stressors and depressive symptoms. Conclusions Our findings have demonstrated that psychosocial stressors at work are related to mental health, and that in most cases this relationship holds true both for people with high and with low resources. Therefore, there is no clear indication that internal or external resources buffer the association between psychosocial work stressors and depressive symptoms.

Effort-Reward Imbalance at Work and Incident Coronary Heart Disease: A Multicohort Study of 90,164 Individuals.

BACKGROUND: Epidemiologic evidence for work stress as a risk factor for coronary heart disease is mostly based on a single measure of stressful work known as job strain, a combination of high demands and low job control. We examined whether a complementary stress measure that assesses an imbalance between efforts spent at work and rewards received predicted coronary heart disease. METHODS: This multicohort study (the "IPD-Work" consortium) was based on harmonized individual-level data from 11 European prospective cohort studies. Stressful work in 90,164 men and women without coronary heart disease at baseline was assessed by validated effort-reward imbalance and job strain questionnaires. We defined incident coronary heart disease as the first nonfatal myocardial infarction or coronary death. Study-specific estimates were pooled by random effects meta-analysis. RESULTS: At baseline, 31.7% of study members reported effort-reward imbalance at work and 15.9% reported job strain. During a mean follow-up of 9.8 years, 1,078 coronary events were recorded. After adjustment for potential confounders, a hazard ratio of 1.16 (95% confidence interval, 1.00-1.35) was observed for effort-reward imbalance compared with no imbalance. The hazard ratio was 1.16 (1.01-1.34) for having either effort-reward imbalance or job strain and 1.41 (1.12-1.76) for having both these stressors compared to having neither effort-reward imbalance nor job strain. CONCLUSIONS: Individuals with effort-reward imbalance at work have an increased risk of coronary heart disease, and this appears to be independent of job strain experienced. These findings support expanding focus beyond just job strain in future research on work stress.

The longitudinal relationship of work stress with peak expiratory flow: a cohort study.

PURPOSE: Research has suggested that psychological stress is associated with reduced lung function and with the development of respiratory disease. Among the major potential sources of stress in adulthood are working conditions. We aimed to examine the relationship of work stress with lung function. METHODS: We drew on 4-year prospective data from the Survey of Health, Ageing and Retirement in Europe. The analyzed sample comprised 2627 workers aged 50 years or older who were anamnestically free of respiratory disease. Work stress at baseline was operationalized by abbreviated instruments measuring the well-established effort-reward imbalance model (seven items) and the control component of the job-demand control (two items). Peak expiratory flow (PEF) was determined at baseline and at follow-up. Continuous and categorized (i.e., by the tertile) work stress variables were employed in multivariable linear regression models to predict PEF change. RESULTS: Work stress did not show statistically significant associations with PEF change. For instance, the unstandardized regression coefficient for PEF decline according to high versus low effort-reward imbalance was -1.41 (95% confidence interval = -3.75, 0.94). CONCLUSIONS: Our study is the first to examine prospective relationships between work stress and PEF. Overall, we did not observe meaningful associations. Future studies should consider a broader spectrum of spirometric parameters and should expand research to younger and possibly less-selected working populations (i.e., aged <50 years).

Country differences of psychosocial working conditions in Europe: the role of health and safety management practices.

BACKGROUND: In times of demographic change, maintaining health and employability of older employees is important. In this context, studies show that stressful working conditions differ by countries. Yet, it is unclear if specific national management practices to deal with these conditions contribute towards explaining country differences. METHODS: This study combines two different data sources. The first one provides detailed information on psychosocial working conditions in 17 European countries, based on 12,284 employees from the Survey of Health, Ageing and Retirement in Europe (SHARE) and the English Longitudinal Study of Ageing (ELSA). We link this information to the second data source that provides information on health and safety management practices in each of the countries under study (collected among 17,477 managers at the level of companies in the Enterprise survey on new and emerging risks (ESENER)). We distinguish six different types of risk management procedures in the analysis. RESULTS: Results show that levels of psychosocial risks are generally lower in countries with more developed management practices, in particular if national management practices are marked by (1) procedures to deal with work stress, (2) information about whom to address in case of work-related psychosocial problems, and (3) health and safety services provided by psychologists. CONCLUSION: The findings underline the importance of a comprehensive psychosocial risk management approach in reducing work-related stress, as lower levels of psychosocial risks are linked to specific psychosocial risk management practices within companies, in particular those pointing to clear responsibilities and coordinated procedures in dealing with psychosocial risks.

Long working hours and cancer risk: a multi-cohort study.

BACKGROUND: Working longer than the maximum recommended hours is associated with an increased risk of cardiovascular disease, but the relationship of excess working hours with incident cancer is unclear. METHODS: This multi-cohort study examined the association between working hours and cancer risk in 116 462 men and women who were free of cancer at baseline. Incident cancers were ascertained from national cancer, hospitalisation and death registers; weekly working hours were self-reported. RESULTS: During median follow-up of 10.8 years, 4371 participants developed cancer (n colorectal cancer: 393; n lung cancer: 247; n breast cancer: 833; and n prostate cancer: 534). We found no clear evidence for an association between working hours and the overall cancer risk. Working hours were also unrelated the risk of incident colorectal, lung or prostate cancers. Working ⩾55 h per week was associated with 1.60-fold (95% confidence interval 1.12-2.29) increase in female breast cancer risk independently of age, socioeconomic position, shift- and night-time work and lifestyle factors, but this observation may have been influenced by residual confounding from parity. CONCLUSIONS: Our findings suggest that working long hours is unrelated to the overall cancer risk or the risk of lung, colorectal or prostate cancers. The observed association with breast cancer would warrant further research.

[Work and health inequalities: The unequal distribution of exposures at work in Germany and Europe]. / Arbeit und gesundheitliche Ungleichheit : Die ungleiche Verteilung von Arbeitsbelastungen in Deutschland und Europa.

BACKGROUND: Health inequalities in the working population may partly be due to the unequal exposure to work-related risk factors among different occupational positions. Empirical data, however, exploring the distribution of exposures at work according to occupational position for Germany is missing. OBJECTIVES: This paper summarizes existing literature on occupational inequalities and discusses the role of working conditions. In addition, using European survey data, we study how various exposures at work vary by occupational class. MATERIALS AND METHODS: Analyses are based on the European Working Condition Survey, and we compare the German sample (n = 2096) with the sample from the EU-27 countries (n = 34,529). To measure occupational position we use occupational class (EGP-classes). First, we describe the prevalence of 16 different exposures at work by occupational class for men and women. Second, we estimate regression models, and thereby investigate if associations between occupational class and self-perceived health are related to an unequal distribution of exposures at work. RESULTS: For various exposures at work we found a higher prevalence among manual workers and lower-skilled employees for both physical and psychosocial conditions. With few exceptions only, this finding was true for men and women and consistent for Germany and Europe. CONCLUSION: Results indicate that the unequal distribution of health-adverse conditions at work contribute towards existing health inequalities among the working population.

Long working hours and risk of coronary heart disease and stroke: a systematic review and meta-analysis of published and unpublished data for 603,838 individuals.

BACKGROUND: Long working hours might increase the risk of cardiovascular disease, but prospective evidence is scarce, imprecise, and mostly limited to coronary heart disease. We aimed to assess long working hours as a risk factor for incident coronary heart disease and stroke. METHODS: We identified published studies through a systematic review of PubMed and Embase from inception to Aug 20, 2014. We obtained unpublished data for 20 cohort studies from the Individual-Participant-Data Meta-analysis in Working Populations (IPD-Work) Consortium and open-access data archives. We used cumulative random-effects meta-analysis to combine effect estimates from published and unpublished data. FINDINGS: We included 25 studies from 24 cohorts in Europe, the USA, and Australia. The meta-analysis of coronary heart disease comprised data for 603,838 men and women who were free from coronary heart disease at baseline; the meta-analysis of stroke comprised data for 528,908 men and women who were free from stroke at baseline. Follow-up for coronary heart disease was 5·1 million person-years (mean 8·5 years), in which 4768 events were recorded, and for stroke was 3·8 million person-years (mean 7·2 years), in which 1722 events were recorded. In cumulative meta-analysis adjusted for age, sex, and socioeconomic status, compared with standard hours (35-40 h per week), working long hours (≥55 h per week) was associated with an increase in risk of incident coronary heart disease (relative risk [RR] 1·13, 95% CI 1·02-1·26; p=0·02) and incident stroke (1·33, 1·11-1·61; p=0·002). The excess risk of stroke remained unchanged in analyses that addressed reverse causation, multivariable adjustments for other risk factors, and different methods of stroke ascertainment (range of RR estimates 1·30-1·42). We recorded a dose-response association for stroke, with RR estimates of 1·10 (95% CI 0·94-1·28; p=0·24) for 41-48 working hours, 1·27 (1·03-1·56; p=0·03) for 49-54 working hours, and 1·33 (1·11-1·61; p=0·002) for 55 working hours or more per week compared with standard working hours (ptrend<0·0001). INTERPRETATION: Employees who work long hours have a higher risk of stroke than those working standard hours; the association with coronary heart disease is weaker. These findings suggest that more attention should be paid to the management of vascular risk factors in individuals who work long hours. FUNDING: Medical Research Council, Economic and Social Research Council, European Union New and Emerging Risks in Occupational Safety and Health research programme, Finnish Work Environment Fund, Swedish Research Council for Working Life and Social Research, German Social Accident Insurance, Danish National Research Centre for the Working Environment, Academy of Finland, Ministry of Social Affairs and Employment (Netherlands), US National Institutes of Health, British Heart Foundation.

Risk and resilience: health inequalities, working conditions and sickness benefit arrangements: an analysis of the 2010 European Working Conditions survey.

In this article we ask whether the level of sickness benefit provision protects the health of employees, particularly those who are most exposed to hazardous working conditions or who have a little education. The study uses the European Working Condition Survey that includes information on 20,626 individuals from 28 countries. Health was measured by self-reported mental wellbeing and self-rated general health. Country-level sickness benefit provision was constructed using spending data from Eurostat. Group-specific associations were fitted using cross-level interaction terms between sickness benefit provision and physical and psychosocial working conditions respectively, as well as those with little education. The mental wellbeing of employees exposed to psychosocial job strain and physical hazards, or who had little education, was better in countries that offer more generous sickness benefit. These results were found in both men and women and were robust to the inclusion of GDP and country fixed effects. In the analyses of self-reported general health, few group-specific associations were found. This article concludes that generous sickness benefit provision may strengthen employee's resilience against mental health risks at work and risks associated with little education. Consequently, in countries with a generous provision of sickness benefit, social inequalities in mental health are smaller.