Mental health differences among middle-aged sawmill workers in rural compared to urban British Columbia.

The study sought to determine whether differences in mental health outcomes were observable in a cohort of workers living in rural compared to urban places in the Canadian province of British Columbia. The study was based on a cohort of male sawmill workers. The cohort was probabilistically linked to the BC Linked Health Database in order to yield objective mental health outcomes. A nested case control design was used. Univariate and multivariate models were constructed using conditional logistic regression. While results differed according to the particular mental health outcome, after controlling for socio-economic confounders it was found that workers who remained in or migrated to rural places tended to have better mental health outcomes than workers who remained in or migrated to urban places.

Rural-urban migration patterns and mental health diagnoses of adolescents and young adults in British Columbia, Canada: a case-control study.

BACKGROUND: The identification of mental health problems early in life can increase the well-being of children and youth. Several studies have reported that youth who experience mental health disorders are also at a greater risk of developing psychopathological conditions later in life, suggesting that the ability of researchers and clinicians to identify mental health problems early in life may help prevent adult psychopathology. Using large-scale administrative data, this study examined whether permanent settlement and within-province migration patterns may be linked to mental health diagnoses among adolescents (15 to 19 years old), young adults (20 to 30 years old), and adults (30 years old and older) who grew up in rural or urban communities or migrated between types of community (N = 8,502). METHODS: We conducted a nested case-control study of the impact of rural compared to urban residence and rural-urban provincial migration patterns on diagnosis of mental health. Conditional logistic regression models were run with the following International Classification of Diseases, 9th Revision (ICD-9) mental health diagnoses as the outcomes: neurotic disorders, personality disorder, acute reaction to stress, adjustment reaction, depression, alcohol dependence, and nondependent drug abuse. Analyses were conducted controlling for paternal mental health and sociodemographic characteristics. RESULTS: Mental health diagnoses were selectively associated with stability and migration patterns. Specifically, adolescents and young adults who were born in and grew up in the same rural community were at lower risk of being diagnosed with acute reaction to stress (OR = 0.740) and depression (OR = 0.881) compared to their matched controls who were not born in and did not grow up in the same rural community. Furthermore, adolescents and young adults migrating between rural communities were at lower risk of being diagnosed with adjustment reaction (OR = 0.571) than those not migrating between rural communities. No differences were found for diagnoses of neurotic disorders, personality disorder, alcohol dependence, and nondependent drug abuse. CONCLUSIONS: This study provides some compelling evidence of the protective role of rural environments in the development of specific mental health conditions (i.e., depression, adjustment reaction, and acute reaction to stress) among the children of sawmill workers in Western Canada.

A case control study of differences in non-work injury and accidents among sawmill workers in rural compared to urban British Columbia, Canada.

BACKGROUND: Using a cohort of British Columbian male sawmill workers, we conducted a nested case-control study of the impact of rural compared to urban residence as well as rural/urban migration patterns in relation to hospitalization for non-work injury. We postulate that for many types of non-work injuries, rates will be higher in rural communities than in urban ones and that rates will also be higher for workers who migrate from urban to rural communities. METHODS: Using conditional logistic regression, univariate models were first run with each of five non-work injury outcomes. These outcomes were hospitalizations due to assault, accidental poisoning, medical mis-adventure, motor vehicle trauma, and other non-work injuries. In multivariate models marital status, ethnicity, duration of employment, and occupation were forced into the model and associations with urban, compared to rural, residence and various urban/migration patterns were tested. RESULTS: Urban or rural residence and migration status from urban to other communities, and across rural communities, were not associated with hospitalization for medical misadventure, assault, or accidental poisoning. The likelihood of a rural resident being hospitalized for motor vehicle trauma is higher than for an urban resident. The likelihood that a rural resident is hospitalized for "other" non-work injury is higher than for an urban resident. CONCLUSION: In a relatively homogenous group of workers, and using a rigorous study design, we have demonstrated that the odds of other non-work injury are much higher for workers resident in and migrating to rural regions of Canada than they are for workers resident in or migrating to urban places.

Paternal psychosocial work conditions and mental health outcomes: a case-control study.

BACKGROUND: The role of social and family environments in the development of mental health problems among children and youth has been widely investigated. However, the degree to which parental working conditions may impact on developmental psychopathology has not been thoroughly studied. METHODS: We conducted a case-control study of several mental health outcomes of 19,833 children of sawmill workers and their association with parental work stress, parental socio-demographic characteristics, and paternal mental health. RESULTS: Multivariate analysis conducted with four distinct age groups (children, adolescents, young adults, and adults) revealed that anxiety based and depressive disorders were associated with paternal work stress in all age groups and that work stress was more strongly associated with alcohol and drug related disorders in adulthood than it was in adolescence and young adulthood. CONCLUSION: This study provides support to the tenet that being exposed to paternal work stress during childhood can have long lasting effects on the mental health of individuals.

The impact of psychosocial work conditions on attempted and completed suicide among western Canadian sawmill workers.

BACKGROUND: Using a large cohort of western Canadian sawmill workers (n = 28,794), the association between psychosocial work conditions and attempted and completed suicide was investigated. METHODS: Records of attempted and completed suicide were accessed through a provincial hospital discharge registry to identify cases that were then matched using a nested case control method. Psychosocial work conditions were estimated by expert raters using the demand-control model. Univariate and multivariate conditional logistic regression was used to estimate the association between work conditions and suicide. RESULTS: In multivariate models, controlling for sociodemographic (marital status, ethnicity) and occupational confounders (job mobility and duration), low psychological demand was associated with increased odds for completed suicide, and low social support was associated with increased odds for attempted suicides. CONCLUSIONS: This study indicates that workers with poor psychosocial working conditions may be at increased risk of both attempted and completed suicide.

Cancer and occupational exposure to pentachlorophenol and tetrachlorophenol (Canada).

OBJECTIVE: The objective of this study is to assess the carcinogenicity of pentachlorophenol and tetrachlorophenol using data from the BC sawmill workers cohort study. METHODS: The cohort consisted of 27,464 men employed by 14 sawmills for 1 year or more between 1950 and 1995. Fatal (1950-1995) and incident (1969-1995) cancers were identified using national registries. Plant records and systematic interviews with senior employees were used to estimate dermal exposure. Comparisons were made with the general BC population and dose-response relationships were assessed using Poisson regression. RESULTS: There were 1,495 fatal cancer and 2,571 incident cancers. There were no large or statistically significant excesses of any of the specific cancers were observed compared to the general population. Internal analyses showed strong dose-response relationships for non-Hodgkin's lymphoma, multiple myeloma, and kidney cancer. These relationships were strongest when exposure was restricted to pentachlorophenol. The strength of the dose-response increased when exposure was lagged by 20 years. CONCLUSIONS: Dermal exposure to pentachlorophenol was associated with non-Hodgkin's lymphoma, multiple myeloma, and kidney cancer, but not with other cancers of a priori interest.

A longitudinal study comparing the effort-reward imbalance and demand-control models using objective measures of physician utilization.

BACKGROUND: The objectives of this study were to compare the predictive validity of the demand-control and effort-reward imbalance models using objective measures of physician utilization. METHODS: Self-reports for psychosocial work conditions were obtained in interviews with 1,028 workers using the demand-control and effort-reward imbalance models. Physician utilization outcomes were obtained through linkage to the British Columbia Linked Health Database. Outcomes were any visit to a physician for mental health reasons and 30 or more physician visits for any reason. The predictive validity of both models was compared in a longitudinal study using logistic regression. RESULTS: Neither job strain nor effort-reward imbalance predicted either outcome. However, low esteem reward and low status control increased the risk for 30 or more physician visits by, respectively, approximately 60% and 30%. CONCLUSIONS: In a sample of middle-aged blue-collar current and ex-sawmill workers in Western Canada, followed prospectively, after controlling for sociodemographic and workplace confounders, and reducing the potential for adverse health selection into high-stress jobs, low esteem reward and low status control were associated with a significantly greater risk for 30 or more physician visits for any reason.