Work-Related Stress Questionnaire: confirmatory factor analysis for construct validation by the PHRASI study.

OBJECTIVE: The purpose of this study is to validate the 13-item version of the Work-Related Stress Questionnaire (WRSQ) on a representative sample of Italian public health residents. MATERIALS AND METHODS: The WRSQ was administered as part of the Public Health Residents' Anonymous Survey in Italy (PHRASI) from 14 June to 26 July 2022. Collinearity between each questionnaire item was assessed with Kendall's τ statistic. The latent factors identified associating similar items based on the authors' observations were workplace, job demand, support and unpleasant workplace. Goodness-of-fit was assessed with confirmatory factor analysis calculating: Comparative Fit Index (CFI), Tucker-Lewis Index (TLI), Root Mean Square Error of Approximation (RMSEA), Standardized Root-Mean-Residual (SRMR). Cronbach's alpha (α) and Omega McDonald (ω) were calculated to evaluate the reliability of the questionnaire. R 4.2.2 was used to perform the analyses. RESULTS: 379 Public Health residents (58% women) responded to the questionnaire. No significant collinearity was found between the items (τ range -0.31 to 0.49). Confirmatory Factor Analysis showed CFI = 0.975, TLI = 0.967, RMSEA = 0.041 and SRMR = 0.051. Internal consistency of the WRSQ Total Score was α = 0.80 and ω = 0.85. CONCLUSIONS: Although validated in a sectorial subpopulation of healthcare workers, the WRSQ proved to be an excellent tool for assessing work-related stress. Unpleasant workplace latent factors showed lower factor loading and internal consistency than others. This could be due to the fact that topics investigated with unpleasant workplace items (e.g., abuse and discrimination) are experienced on a less regular basis than the ones assessed through the other items.

One-year trajectories of mental health and work outcomes post return to work in patients with common mental disorders.

BACKGROUND: We investigated one-year trajectories of symptom recovery, work functioning and the return to work percentage (RTW%) among patients with common mental disorders (CMDs). METHODS: Data were used from a cluster-randomised controlled trial evaluating a problem-solving intervention for CMD patients (N = 158) who had returned to work. Information on anxiety and depressive symptoms, work functioning and RTW% was collected at baseline and 3, 6 and 12 months follow-up. Latent class growth analyses were used to identify trajectories for the four outcomes and investigate how these trajectories clustered in higher order latent classes. Additionally, we investigated the relation between patient characteristics and class membership. RESULTS: We identified four trajectories for all four outcomes and derived three higher order latent classes: slow recovery (42% [66/158]) (high anxiety and depressive symptoms, moderate to low work functioning and fast RTW); fast recovery (25% [40/158]) (low anxiety and depressive symptoms, high work functioning and fast RTW); and gradual recovery (33% [52/158] (decreasing anxiety and depressive symptoms, increasing or low work functioning and fast RTW). Participants with a higher work engagement and readiness to stay at work were more likely to belong to the fast recovery class. LIMITATIONS: Due to the relatively small sample size, some trajectories consisted of few participants. Symptom severity was self-reported. CONCLUSIONS: Many CMD patients experience high levels of mental health symptoms and work functioning problems during the year post RTW. Creating realistic recovery expectations (for both patients and their environments) could be important for successful and sustainable recovery and work participation.

Longitudinal associations of experiences of adversity and socioeconomic disadvantage during childhood with labour force participation and exit in later adulthood.

The Extending Working Lives (EWL) agenda seeks to sustain employment up to and beyond traditional retirement ages. This study examined the potential role of childhood factors in shaping labour force participation and exit among older adults, with a view to informing proactive interventions early in the life-course to enhance individuals' future capacity for extending their working lives. Childhood adversity and socioeconomic disadvantage have previously been linked to ill-health across the life-span and sickness benefit in early adulthood. This study builds upon previous research by examining associations between childhood adversity and self-reported labour force participation among older adults (aged 55). Data was from the National Child Development Study - a prospective cohort of all English, Scottish, & Welsh births in one week in 1958. There was evidence for associations between childhood adversity and increased risk of permanent sickness at 55 years - which were largely sustained after adjustment for educational disengagement and adulthood factors (mental/physical health, qualifications, socioeconomic disadvantage). Specifically, children who were abused or neglected were more likely to be permanently sick at 55 years. In addition, among males, those in care, those experiencing illness in the home, and those experiencing two or more childhood adversities were more likely to be permanently sick at 55 years. Childhood factors were also associated with part-time employment and retirement at 55 years. Severe childhood adversities may represent important distal predictors of labour force exit at 55 years, particularly via permanent sickness. Notably, some adversities show associations among males only, which may inform interventions designed to extend working lives.

Impact of childhood and adulthood psychological health on labour force participation and exit in later life.

BACKGROUND: Adulthood psychological health predicts labour force activity but few studies have examined childhood psychological health. We hypothesized that childhood psychological ill-health would be associated with labour force exit at 55 years. METHOD: Data were from the 55-year follow-up of the National Child Development Study (n = 9137). Labour force participation and exit (unemployment, retirement, permanent sickness, homemaking/other) were self-reported at 55 years. Internalizing and externalizing problems in childhood (7, 11 and 16 years) and malaise in adulthood (23, 33, 42, 50 years) were assessed. Education, social class, periods of unemployment, partnership separations, number of children, and homemaking activity were measured throughout adulthood. RESULTS: Childhood internalizing and externalizing problems were associated with unemployment, permanent sickness and homemaking/other at 55 years, after adjustment for adulthood psychological health and education: one or two reports of internalizing was associated with increased risk for unemployment [relative risk (RR) 1.59, 95% confidence interval (CI) 1.12-2.25; RR 2.37, 95% CI 1.48-3.79] and permanent sickness (RR 1.32, 95% CI 1.00-1.74; RR, 1.48, 95% CI 1.00-2.17); three reports of externalizing was associated with increased risk for unemployment (RR 2.26, 95% CI 1.01-5.04), permanent sickness (RR 2.63, 95% CI 1.46-4.73) and homemaking/other (RR 1.95, 95% CI 1.00-3.78). CONCLUSIONS: Psychological ill-health across the lifecourse, including during childhood, reduces the likelihood of working in older age. Support for those with mental health problems at different life stages and for those with limited connections to the labour market, including homemakers, is an essential dimension of attempts to extend working lives.

Childhood adversity and midlife suicidal ideation.

BACKGROUND: Childhood adversity predicts adolescent suicidal ideation but there are few studies examining whether the risk of childhood adversity extends to suicidal ideation in midlife. We hypothesized that childhood adversity predicts midlife suicidal ideation and this is partially mediated by adolescent internalizing disorders, externalizing disorders and adult exposure to life events and interpersonal difficulties. METHOD: At 45 years, 9377 women and men from the UK 1958 British Birth Cohort Study participated in a clinical survey. Childhood adversity was prospectively assessed at the ages of 7, 11 and 16 years. Suicidal ideation at midlife was assessed by the depressive ideas subscale of the Revised Clinical Interview Schedule. Internalizing and externalizing disorders were measured by the Rutter scales at 16 years. Life events, periods of unemployment, partnership separations and alcohol dependence were measured through adulthood. RESULTS: Illness in the household, paternal absence, institutional care, parental divorce and retrospective reports of parental physical and sexual abuse predicted suicidal ideation at 45 years. Three or more childhood adversities were associated with suicidal ideation at 45 years [odds ratio (OR) 4.31, 95% confidence interval (CI) 2.67-6.94]. Psychological distress at 16 years partially mediated the associations of physical abuse (OR 3.41, 95% CI 2.29-5.75), sexual abuse (OR 4.99, 95% CI 2.90-11.16) with suicidal ideation. Adult life events partially mediated the association of parental divorce (OR 6.34, 95% CI -7.16 to 36.75) and physical (OR 9.59, 95% CI 4.97-27.88) and sexual abuse (OR 6.59, 95% CI 2.40-38.36) with suicidal ideation at 45 years. CONCLUSIONS: Adversity in childhood predicts suicidal ideation in midlife, partially mediated by adolescent internalizing and externalizing disorders, adult life events and interpersonal difficulties. Understanding the pathways from adversity to suicidal ideation can inform suicide prevention and the targeting of preventive interventions.

Job stress: an in-depth investigation based on the HSE questionnaire and a multistep approach in order to identify the most appropriate corrective actions.

BACKGROUND: Psychosocial hazards and work-related stress have reached epidemic proportions in Europe. The Italia law introduced in 2008 the obligation for Italian companies to assess work related stress risk in order to protect their workers' safety and health. The purpose of our study was to propose an accurate measurement tool, using the HSE indicator tool, for more appropriate and significant work-related stress' prevention measures. METHODS: The study was conducted on 204 visual display unit (VDU) operators: 106 male and 98 female. All subjects were administered the HSE questionnaire. The sample was studied through a 4 step process, using HSE analysis tool and a statistical analysis, based on the odds ratio calculation. RESULTS: The assessment model used demonstrated the presence of work related stress in VDU operators and additional "critical" aspects which had failed to emerge by the classical use of HSE analysis tool. DISCUSSION: The approach we propose allows to obtain a complete picture of the perception of work-related stress and can point out the most appropriate corrective actions.

Noise sensitivity and future risk of illness and mortality.

Aircraft and road traffic noise exposure increase the risk of cardiovascular disease (CVD). Noise annoyance is the most frequent response to environmental noise. Noise annoyance has been shown to modify the association of transport noise exposure on CVD and noise sensitivity moderates the annoyance response to noise. This study uses prospective data from phases 1, 3, 5, 7 and 9 in 3630 male and female civil servants from the UK Whitehall II Study to examine whether a single question on noise sensitivity measured by annoyance responses to noise in general predicts physical and mental ill-health and mortality. Non-fatal myocardial infarction and stroke morbidity over the follow-up were defined by MONICA criteria based on study ECGs, hospital records, hospital admission statistics or General Practitioner confirmation. Depressive symptoms were measured by the Center for Epidemiologic Studies Depression Scale (CES-D) and psychological distress by the General Health questionnaire (GHQ). There was no association between noise sensitivity and CVD morbidity or mortality except in people from lower employment grades where there was an association with angina. Noise sensitivity was a consistent predictor of depressive symptoms and psychological distress at phases 3, 5 and 7. High noise sensitivity scores at baseline predicted GHQ caseness at phase 3 adjusting for age, sex, employment grade, self-rated health and GHQ caseness at baseline (OR=1.56 95% CI 1.29-1.88). Noise sensitivity has been identified as a predictor of mental ill-health. More longitudinal research is needed including measures of noise exposure.

School bullying and traumatic dental injuries in East London adolescents.

AIM: To explore the association between school bullying and traumatic dental injuries (TDI) among 15-16-year-old school children from East London. DESIGN: Data from phase III of the Research with East London Adolescents Community Health Survey (RELACHS), a school-based prospective study of a representative sample of adolescents, were analysed. Adolescents provided information on demographic characteristics, socioeconomic measures and frequency of bullying in school through self-administered questionnaires and were clinically examined for overjet, lip coverage and TDI. The association between school bullying and TDI was assessed using binary logistic regression models. RESULTS: The prevalence of TDI was 17%, while lifetime and current prevalence of bullying was 32% and 11%, respectively. The prevalence of TDI increased with a growing frequency of bullying; from 16% among adolescents who had never been bullied at school, to 21% among those who were bullied in the past but not this school term, to 22% for those who were bullied this school term. However, this association was not statistically significant either in crude or adjusted regression models. CONCLUSION: There was no evidence of an association between frequency of school bullying and TDI in this sample of 15-16-year-old adolescents in East London.

Born into adversity: psychological distress in two birth cohorts of second-generation Irish children growing up in Britain.

BACKGROUND: Worldwide, the Irish diaspora experience health inequalities persisting across generations. The present study sought to establish the prevalence of psychological morbidity in the children of migrant parents from Ireland, and reasons for differences. METHODS: Data from two British birth cohorts were used for analysis. Each surveyed 17 000 babies born in one week in 1958 and 1970 and followed up through childhood. Validated scales assessed psychological health. RESULTS: Relative to the rest of the cohort, second-generation Irish children grew up in material hardship and showed greater psychological problems at ages 7, 11 (1958 cohort) and 16 (both cohorts). Adjusting for material adversity and maternal psychological distress markedly reduced differences. Relative to non-Irish parents, Irish-born parents were more likely to report chronic health problems (odds ratio [OR]: 1.29; 95% confidence interval [CI]: 1.08-1.54), and Irish-born mothers were more likely to be psychologically distressed (OR: 1.44; 95% CI: 1.13-1.84, when child was 10). Effect sizes diminished once material adversity was taken into account. CONCLUSIONS: Second-generation Irish children experienced high levels of psychological morbidity, but this was accounted for through adverse material circumstances in childhood and psychological distress in parents. Public health initiatives focusing on settlement experiences may reduce health inequalities in migrant children.

Use of self-administered instruments to assess psychiatric disorders in older people: validity of the General Health Questionnaire, the Center for Epidemiologic Studies Depression Scale and the self-completion version of the revised Clinical Interview Schedule.

BACKGROUND: Diagnosis of depressive disorder using interviewer-administered instruments is expensive and frequently impractical in large epidemiological surveys. The aim of this study was to assess the validity of three self-completion measures of depressive disorder and other psychiatric disorders in older people against an interviewer-administered instrument. METHOD: A random sample stratified by sex, age and social position was selected from the Whitehall II study participants. This sample was supplemented by inclusion of depressed Whitehall II participants. Depressive disorder and other mental disorders were assessed by the interviewer-administered structured revised Clinical Interview Schedule (CIS-R) in 277 participants aged 58-80 years. Participants also completed a computerized self-completion version of the CIS-R in addition to the General Health Questionnaire (GHQ) and the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS: The mean total score was similar for the interviewer-administered (4.43) and self-completion (4.35) versions of the CIS-R [95% confidence interval (CI) for difference -0.31 to 0.16]. Differences were not related to sex, age, social position or presence of chronic physical illness. Sensitivity/specificity of self-completion CIS-R was 74%/98% for any mental disorder and 75%/98% for depressive episode. The corresponding figures were 86%/87% and 78%/83% for GHQ and 77%/89% and 89%/86% for CES-D. CONCLUSIONS: The self-completion computerized version of the CIS-R is feasible and has good validity as a measure of any mental disorder and depression in people aged ≥ 60 years. GHQ and CES-D also have good criterion validity as measures of any mental disorder and depressive disorder respectively.

Occupations, work characteristics and common mental disorder.

BACKGROUND: The present study aimed to assess the prevalence of common mental disorders (CMDs) by occupation in a representative sample of the English adult population. Another aim was to examine whether the increased risk of CMD in some occupations could be explained by adverse work characteristics. Method We derived a sample of 3425 working-age respondents from the Adult Psychiatric Morbidity Survey 2007. Occupations were classified by Standard Occupational Classification group, and CMD measured by the Revised Clinical Interview Schedule. Job characteristics were measured by questionnaire, and tested as explanatory factors in associations of occupation and CMD. RESULTS: After adjusting for age, gender, housing tenure and marital status, caring personal service occupations had the greatest risk of CMD compared with all occupations (odds ratio 1.73, 95% confidence interval 1.16-2.58). The prevalence of adverse psychosocial work characteristics did not follow the pattern of CMD by occupation. Work characteristics did not explain the increased risk of CMDs associated with working in personal service occupations. Contrary to our hypotheses, adding work characteristics individually to the association of occupation and CMD tended to increase rather than decrease the odds for CMD. CONCLUSIONS: As has been found by others, psychosocial work characteristics were associated with CMD. However, we found that in our English national dataset they could not explain the high rates of CMD in particular occupations. We suggest that selection into occupations may partly explain high CMD rates in certain occupations. Also, we did not measure emotional demands, and these may be important mediators of the relationship between occupation type and CMDs.

Common mental disorders, unemployment and psychosocial job quality: is a poor job better than no job at all?

BACKGROUND: Employment is associated with health benefits over unemployment, but the psychosocial characteristics of work also influence health. There has, however, been little research contrasting the prevalence of psychiatric disorders among people who are unemployed with those in jobs of differing psychosocial quality. METHOD: Analysis of data from the English Adult Psychiatric Morbidity Survey (APMS) considered the prevalence of common mental disorders (CMDs) among 2603 respondents aged between 21 and 54 years who were either (i) employed or (ii) unemployed and looking for work at the time of interview in 2007. Quality of work was assessed by the number of adverse psychosocial job conditions reported (low control, high demands, insecurity and low job esteem). RESULTS: The prevalence of CMDs was similar for those respondents who were unemployed and those in the poorest quality jobs. This pattern remained after controlling for relevant demographic and socio-economic covariates. CONCLUSIONS: Although employment is thought to promote mental health and well-being, work of poor psychosocial quality is not associated with any better mental health than unemployment. Policy efforts to improve community mental health should consider psychosocial job quality in conjunction with efforts to increase employment rates.

Interrelationship of depression, stress and inflammation in cancer patients: a preliminary study.

OBJECTIVE: Depression is common in cancer patients and detrimentally affects patients' quality of life. Both depression and stress are associated with raised inflammatory marker levels. This prospective study of cancer patients focuses on childhood trauma, recent life events and inflammatory marker levels as risk factors for high post-surgery depressive symptoms. METHODS: Ninety cancer patients (56 head and neck, 34 colorectal) completed the Hospital Anxiety and Depression Scale, pre-surgery and six, 12 and 24 weeks post-surgery. Recent life events and childhood trauma were assessed at six and 12 weeks respectively. Blood samples were taken pre- and one and six weeks post-surgery to measure C-reactive protein (CRP) and pro-inflammatory cytokine levels. RESULTS: Childhood trauma and recent life events were risk factors for higher depressive symptom levels. In colorectal cancer patients, baseline CRP levels were associated with depressive symptom levels at six (p=0.008) and 12 weeks (p=0.038). Baseline and six week Tumour Necrosis Factor-alpha (TNFα) levels were significantly associated with higher depressive symptoms at later time points after adjusting for cancer-related variables. Childhood trauma was positively associated with TNFα and CRP levels in colorectal cancer patients. The associations between inflammatory markers and depressive symptoms were not significant after adjusting for childhood trauma. LIMITATIONS: Small sample size. CONCLUSIONS: Raised inflammatory mediator levels may be risk factors for depressive symptoms in colorectal cancer patients and thus worth considering as a potential therapeutic target. These pilot data support recent findings demonstrating long-term effects of childhood adversity on adult health.

Annoyance and other reaction measures to changes in noise exposure - a review.

INTRODUCTION: Noise is increasingly recognised as a potentially important environmental pollutant but most studies on human responses to noise exposure relate to steady state situations. Effects may differ when noise changes rapidly, e.g. after noise mitigation interventions or with changes in road or airport configurations. METHODS: A systematic review of studies on human reactions to changes in environmental noise exposures published from 1980 to March 2011 was conducted. RESULTS: 41 papers satisfied the inclusion criteria. The most commonly studied outcomes were annoyance (23 papers) and sleep disturbance (11 papers). Other reactions were well-being, activity disturbance and use of living environment. No studies including physiological or disease measures were identified. The most commonly used study design was a written survey. Studies were methodologically diverse and it was not possible to conduct a formal meta-analysis. Annoyance was not necessarily decreased by reducing noise exposure. Non-acoustical factors influenced annoyance ratings and some of these were not identical to those in steady state conditions. There was insufficient evidence to recommend sleep disturbance as an alternative measure of reactions in changed noise conditions. CONCLUSIONS: Surveys of health effects in changed noise situations should be conducted both before and after the change. Annoyance as a reaction indicator should be evaluated with caution as non-acoustical factors play an important role in annoyance ratings. Technical interventions reducing noise levels may therefore not have impacts on annoyance proportionate to their impacts on sound levels. Further studies, investigating impacts on health endpoints (e.g. blood pressure) in changed noise situations are needed.

Migration, social mobility and common mental disorders: critical review of the literature and meta-analysis.

OBJECTIVE: Changes in socio-economic position in people who migrate may have adverse associations with mental health. The main objective of this review was to assess the association of social mobility with common mental disorders in migrant and second-generation groups, to inform future research. DESIGN: Systematic review and meta-analysis of English-language studies assessing the association of social mobility in migrant or second-generation groups with common mental disorders. Approaches to operationalise 'social mobility' were reviewed. RESULTS: Twelve studies (n=18,548) met criteria for retrieval. Very few included second-generation groups, and most studies were cross-sectional in design. Approaches to operationalise 'social mobility' varied between studies. Downward intragenerational social mobility was associated with migration in the majority of studies. Random effects meta-analysis (n=5179) suggested that migrants to higher income countries who experienced downward mobility or underemployment were more likely to screen positive for common mental disorders, relative to migrants who were upwardly mobile or experienced no changes to socio-economic position. Conclusions on second-generation groups were limited by the lack of research highlighted for these groups. Downward intragenerational mobility associated with migration may be associated with vulnerability to common mental disorders in some migrant groups. CONCLUSION: Given the increasing scale of global migration, further research is needed to clarify how changes to socio-economic position associated with international migration may impact on the mental health of migrants, and in their children.

Roles of different sources of social support on caries experience and caries increment in adolescents of East london.

Evidence on the contribution of social support to oral health is scarce. We first explored the association of social support with caries experience and the relative roles of support from family, friends and a special person on caries experience in 15-16-year-old adolescents. We then explored whether social support at 11-12 years of age predicts caries increment in second permanent molars over 4 years and the relative roles of different sources of support on 4-year caries increment. Data from phases 1 and 3 of the Research with East London Adolescents Community Health Survey (RELACHS), a school-based prospective study of a representative sample of adolescents in East London, were used for cross-sectional (phase 3) and longitudinal analyses (phases 1 and 3). Data were collected by questionnaires including the same questions on demographic characteristics, socioeconomic measures and the Multidimensional Scale of Perceived Social Support at phases 1 and 3. A questionnaire section on dental behaviours and an oral clinical examination were also included in phase 3. Social support was negatively related to both caries experience and increment independently of demographic characteristics, socioeconomic measures and dental behaviours. Furthermore, only support from a special person was significantly related to caries experience and increment in unadjusted and adjusted regression models. In conclusion, adolescents who perceived higher levels of social support had lower caries experience and increment. However, support from a special person was more relevant for these adolescents than support from family and peers.

Long working hours and symptoms of anxiety and depression: a 5-year follow-up of the Whitehall II study.

BACKGROUND: Although long working hours are common in working populations, little is known about the effect of long working hours on mental health. METHOD: We examined the association between long working hours and the onset of depressive and anxiety symptoms in middle-aged employees. Participants were 2960 full-time employees aged 44 to 66 years (2248 men, 712 women) from the prospective Whitehall II cohort study of British civil servants. Working hours, anxiety and depressive symptoms, and covariates were measured at baseline (1997-1999) followed by two subsequent measurements of depressive and anxiety symptoms (2001 and 2002-2004). RESULTS: In a prospective analysis of participants with no depressive (n=2549) or anxiety symptoms (n=2618) at baseline, Cox proportional hazard analysis adjusted for baseline covariates showed a 1.66-fold [95% confidence interval (CI) 1.06-2.61] risk of depressive symptoms and a 1.74-fold (95% CI 1.15-2.61) risk of anxiety symptoms among employees working more than 55 h/week compared with employees working 35-40 h/week. Sex-stratified analysis showed an excess risk of depression and anxiety associated with long working hours among women [hazard ratios (HRs) 2.67 (95% CI 1.07-6.68) and 2.84 (95% CI 1.27-6.34) respectively] but not men [1.30 (0.77-2.19) and 1.43 (0.89-2.30)]. CONCLUSIONS: Working long hours is a risk factor for the development of depressive and anxiety symptoms in women.

Common mental disorders, unemployment and welfare benefits in England.

OBJECTIVES: Individuals who are out of work have a higher rate of common mental disorders (CMD) than individuals who are employed. People who are unemployed in the UK are entitled to welfare benefits to alleviate financial strain. This study examined rates of CMD in individuals who were employed, unemployed and receiving various UK benefits. It also investigated associations between duration of unemployment, gender and CMD. STUDY DESIGN: An analysis of 5090 working-age participants from the Adult Psychiatric Morbidity Survey 2007, a stratified probability sample survey conducted among adults aged 16 years and over living in private households in England. METHODS: CMD was assessed using the Clinical Interview Schedule (Revised). Information was gathered on sociodemographics, employment, income, benefits and debt. Data were analysed using logistic regression. RESULTS: Risk of CMD was significantly greater in individuals classified as: unemployed; economically inactive; not working due to physical health reasons; unable to find a suitable job; receiving housing, care or sickness benefit; and receiving income support. However, risk of CMD was not significantly greater in individuals receiving jobseeker's allowance. Individuals unemployed for less than 1 year or more than 3 years had a higher risk of CMD. Some interactions with gender were significant, with associations being greater in men than women. CONCLUSIONS: Job loss events are not the only reason for unemployed people to develop CMD. The state of unemployment itself may be detrimental to mental health. Risk of CMD is increased in those who have been out of work for 3 years or more. Associations between benefits and mental health are likely to be due to social, health or economic circumstances associated with benefit eligibility.

Psychosocial work characteristics and anxiety and depressive disorders in midlife: the effects of prior psychological distress.

OBJECTIVES: The association between work stressors and adult psychiatric diagnoses may be biased by prior psychological distress influencing perception of work or selection into unfavourable work. This study examines the extent to which the association between work stressors and adult psychiatric diagnoses is explained by associations with earlier psychological distress and whether childhood and early adulthood psychological distress influences reported midlife work characteristics. METHODS: Follow-up at 45 years of age of 8243 participants in paid employment from the 1958 British Birth Cohort. Karasek's work characteristics and psychiatric diagnoses (Revised Clinical Interview Schedule) were measured at 45 years. Childhood internalising and externalising problems were measured at 7, 11 and 16 and malaise at 23 and 33 years. RESULTS: Internalising behaviours in childhood and early adult psychological distress predicted adverse work characteristics in mid-adulthood. High job demands (women: relative risk (RR) = 1.75, 95% CI 1.2 to 2.5; men: RR = 4.99, 95% CI 2.5 to 10.1), low decision latitude (RR = 1.46, 95% CI 1.1 to 1.9), high job strain (OR = 1.88, 95% CI 1.5 to 2.4), low work social support (RR = 1.97, 95% CI 1.5 to 2.6) and high job insecurity (OR = 1.86, 95% CI 1.4 to 2.4) were associated with mid-adulthood diagnoses. The association between work stressors and mid-adulthood diagnoses remained after adjustment for internalising behaviours and malaise at 23 and 33 years although diminished slightly in magnitude (eg, adjusted RR for support = 1.82, 95% CI 1.4 to 2.4; job strain OR = 1.78, 95% CI 1.4 to 2.3). CONCLUSIONS: Childhood and early adulthood psychological distress predict work characteristics in mid-adulthood but do not explain the associations of work characteristics with depressive episode and generalised anxiety disorder in midlife. Work stressors are an important source of preventable psychiatric diagnoses in midlife. Psychological distress may influence selection into less advantaged occupations with poorer working conditions that may increase the risk of future depressive and anxiety disorders.

Lifecourse socioeconomic predictors of midlife drinking patterns, problems and abstention: findings from the 1958 British Birth Cohort Study.

BACKGROUND: Research suggests that outcomes associated with drinking may differ depending upon patterns of consumption, drinking related symptoms and social problems. This paper investigated socioeconomic predictors (measuring multiple indices, period and consistency of disadvantage) of midlife drinking patterns. METHODS: Socioeconomic information from the 1958 British Birth Cohort Study (n=9146) included: manual socioeconomic position and owner/buyer residential tenure (7, 11, 16, 33 and 42 y), and educational attainment (33 y). At 45 y, the overlap between drinking patterns was explored using the Alcohol Use Disorders Identification Test. Patterns included: 'Moderate-binge' (binge drinkers with low-problem scores, consuming within UK sensible drinking weekly guidelines); Low-Problem Heavy (LPH) drinkers (regardless of binge); 'Problem' (and heavy or binge) and 'Non-/occasional' (< or =monthly) drinkers. These categories were compared to 'Low-risk' drinkers. RESULTS: Socioeconomic disadvantage was consistently associated with moderate-binge, non-/occasional and problem but not LPH drinking. The highest risk was associated with multiple and persistent disadvantage across childhood and adulthood; this risk was partially accounted for education. Non-/occasional and moderate-binge drinking was predicted by disadvantage during childhood alone. The socioeconomic disadvantage of non-/occasional drinkers was not explained by past problem or heavy drinking. CONCLUSIONS: Socioeconomic disadvantage across the lifecourse was consistently linked to specific drinking patterns. Furthermore, associations linking socioeconomic disadvantage with drinking patterns will typically be underestimated if multiple and persistent disadvantage is not investigated. The role of persistent socioeconomic disadvantage in the poor health of non-drinkers and moderate-binge drinkers needs investigation. The findings support current initiatives targeting the reduction of social and individual costs associated with specific drinking patterns.