Effect of trade unions on the mental health of UK workers before and during the COVID-19 pandemic: a longitudinal analysis using Understanding Society data.

BACKGROUND: Although trade union membership rates have continuously decreased over the past 30 years, about 50% of UK employees are still represented by a union. Yet, studies on the association between collective bargaining and workers' mental health are sparse, especially in the pandemic context. This study examines differences on UK workers' mental health due to trade union presence and membership between pre-pandemic and pandemic periods. METHODS: In this longitudinal study, we analysed Understanding Society panel data in which the same participants are followed over time. The data concerned individuals aged 16 years and older and were collected biannually before COVID-19 pandemic (Waves 8-10: 2017-2020) and on a more frequent basis during pandemic (all COVID-19 surveys from 2020 [April, May, June, July, September, November] to 2021 [January, March, September] periods). The primary outcome was General Health Questionnaire-12 (GHQ-12) caseness (GHQ-12 score ≥4: probability of caseness). Two exposures were used separately: trade union presence and trade union membership, interacting with a binary variable splitting time periods between before and during the pandemic. Our analytical sample included 49 915 observations from 5988 individuals. 3341 (56%) individuals worked in unionised workplaces. We fitted mixed-effects logistic regression models adjusting for age, gender, ethnicity, UK residence, educational level, financial situation, workplace size, and survey interview date. We then replicated the analyses including a 3-way interaction with industry. All Understanding Society participants gave written informed consent. Ethics approval was not required. FINDINGS: In our sample, approximately 41% were male and 59% were female, and the mean age was 47·2 years (SD 11·4). Comparing pre-pandemic and pandemic periods, we found that the odds of GHQ-12 caseness for those in non-unionised workplaces increased by 45% (odds ratio 1·45, 95% CI 1·17-1·80), whereas in unionised workplaces odds increased by 28% (1·28, 1·05-1·57). When analysis was confined to unionised workplaces, the odds of GHQ-12 caseness for non-union members increased more (1·40, 1·07-1·83) compared with members (1·18, 0·91-1·53); however, with wide CIs. Overall, industry had no modification effect in both exposures. Sensitivity analysis using GHQ-36 as a continuous outcome demonstrated no real change in the patterns of the results. INTERPRETATION: The mental health of workers in unionised workplaces appears to have worsened less than the mental health of those in non-unionised workplaces; however, there is insufficient evidence of effect differential by type of industrial sector. Designing policies that encourage and facilitate trade union presence in workplaces should be promoted, as they are likely to mitigate adverse mental health effects in times of extreme uncertainty. FUNDING: Medical Research Council, Chief Scientist Office, Belgian National Scientific Fund.

Occupational differences in the prevalence and severity of long-COVID: analysis of the Coronavirus (COVID-19) Infection Survey.

OBJECTIVES: To establish whether prevalence and severity of long-COVID symptoms vary by industry and occupation. METHODS: We used Office for National Statistics COVID-19 Infection Survey (CIS) data (February 2021-April 2022) of working-age participants (16-65 years). Exposures were industry, occupation and major Standard Occupational Classification (SOC) group. Outcomes were self-reported: (1) long-COVID symptoms and (2) reduced function due to long-COVID. Binary (outcome 1) and ordered (outcome 2) logistic regression were used to estimate odds ratios (OR)and prevalence (marginal means). RESULTS: Public facing industries, including teaching and education, social care, healthcare, civil service, retail and transport industries and occupations, had the highest likelihood of long-COVID. By major SOC group, those in caring, leisure and other services (OR 1.44, 95% CIs 1.38 to 1.52) had substantially elevated odds than average. For almost all exposures, the pattern of ORs for long-COVID symptoms followed SARS-CoV-2 infections, except for professional occupations (eg, some healthcare, education, scientific occupations) (infection: OR<1 ; long-COVID: OR>1). The probability of reporting long-COVID for industry ranged from 7.7% (financial services) to 11.6% (teaching and education); whereas the prevalence of reduced function by 'a lot' ranged from 17.1% (arts, entertainment and recreation) to 22%-23% (teaching and education and armed forces) and to 27% (not working). CONCLUSIONS: The risk and prevalence of long-COVID differs across industries and occupations. Generally, it appears that likelihood of developing long-COVID symptoms follows likelihood of SARS-CoV-2 infection, except for professional occupations. These findings highlight sectors and occupations where further research is needed to understand the occupational factors resulting in long-COVID.

Potential contribution of vaccination uptake to occupational differences in risk of SARS-CoV-2: analysis of the ONS COVID-19 Infection Survey.

OBJECTIVES: To assess variation in vaccination uptake across occupational groups as a potential explanation for variation in risk of SARS-CoV-2 infection. DESIGN: We analysed data from the UK Office of National Statistics COVID-19 Infection Survey linked to vaccination data from the National Immunisation Management System in England from 1 December 2020 to 11 May 2022. We analysed vaccination uptake and SARS-CoV-2 infection risk by occupational group and assessed whether adjustment for vaccination reduced the variation in risk between occupational groups. RESULTS: Estimated rates of triple vaccination were high across all occupational groups (80% or above), but were lowest for food processing (80%), personal care (82%), hospitality (83%), manual occupations (84%) and retail (85%). High rates were observed for individuals working in health (95% for office based, 92% for those in patient-facing roles) and education (91%) and office-based workers not included in other categories (90%). The impact of adjusting for vaccination when estimating relative risks of infection was generally modest (ratio of hazard ratios across all occupational groups reduced from 1.37 to 1.32), but was consistent with the hypothesis that low vaccination rates contribute to elevated risk in some groups. CONCLUSIONS: Variation in vaccination coverage might account for a modest proportion of occupational differences in infection risk. Vaccination rates were uniformly very high in this cohort, which may suggest that the participants are not representative of the general population. Accordingly, these results should be considered tentative pending the accumulation of additional evidence.

The effect of school summer holidays on inequalities in children and young people's mental health and cognitive ability in the UK using data from the millennium cohort study.

BACKGROUND: Summer learning loss has been the subject of longstanding concern among researchers, the public and policy makers. The aim of the current research was to investigate inequality changes in children's mental health and cognitive ability across the summer holidays. METHODS: We conducted linear and logistic regression analysis of mental health (borderline-abnormal total difficulty and prosocial scores on the strengths and difficulties questionnaire (SDQ)) and verbal cognitive ability (reading, verbal reasoning or vocabulary) at ages 7, 11 and 14, comparing UK Millennium Cohort Study members who were interviewed before and after the school summer holidays. Inequalities were assessed by including interaction terms in the outcome models between a discrete binary variable with values representing time periods and maternal academic qualifications. Coefficients of the interaction terms were interpreted as changes from the pre- to post-holiday period in the extent of inequality in the outcome between participants whose mothers had high or low educational qualifications. Separate models were fitted for each age group and outcome. We used inverse probability weights to allow for differences in the characteristics of cohort members assessed before and after the summer holidays. RESULTS: Mental health (borderline/abnormal SDQ total and prosocial scores) at ages 7 and 14 worsened and verbal cognitive ability scores at age 7 were lower among those surveyed after the summer holidays. Mental health inequalities were larger after the holidays at age 7 ([OR = 1.4; 95%CI (0.6, 3.2) and 14: [OR = 1.5; 95%CI (0.7, 3.2)], but changed little at age 11 (OR = 0.9; 95%CI (0.4, 2.6)]. There were differences in pro-social behaviours among those surveyed before/after the school holidays at age 14 [OR = 1.2; 95%CI (0.5, 3.5)] but not at age 7 or 11. There was little change in inequalities in verbal cognitive ability scores over the school holidays [Age 7: b = 1.3; 95%CI (- 3.3, 6.0); Age 11: b = - 0.7; 95%CI (- 4.3, 2.8); Age 14: b = - 0.3; 95%CI (- 1.0, 0.4)]. CONCLUSION: We found inequalities in mental health and cognitive ability according to maternal education, and some evidence or worsening mental health and mental health inequalities across school summer holidays. We found little evidence of widening inequalities in verbal cognitive ability. Widespread school closures during the COVID-19 restrictions have prompted concerns that prolonged closures may widen health and educational inequalities. Management of school closures should focus on preventing or mitigating inequalities that may arise from differences in the support for mental health and learning provided during closures by schools serving more or less disadvantaged children.

COVID-19 lockdowns and working women's mental health: Does motherhood and size of workplace matter? A comparative analysis using understanding society.

The COVID-19 pandemic had detrimental and unequal repercussions on mental health. To date there is little evidence exploring how motherhood and workplace size moderates this relationship for working women. This study aimed to estimate changes in working women's mental health at the start of each UK lockdown and estimate the effect of motherhood and workplace size on mental health. We used Understanding Society data from women in paid employment, who participated in at least: one pre-COVID-19 Wave (9 or 10/11) and one COVID-19 lockdown wave (Lockdown 1: April 2020, Lockdown 2: November 2020, Lockdown 3: January 2021). Primary outcome was probable psychological distress (i.e., score≥4 in the General Health Questionnaire-12 (GHQ-12)). In Model 1, exposure was motherhood (binary), interacting with a variable that split time in the pre-pandemic and lockdown periods. In Model 2, workplace size (Micro:1-24, Medium: 25-199, Large: More than 200 employees) was added as an exposure (3-way interaction) to investigate moderation effects. We fitted mixed-effects logistic regression models, adjusting for age, ethnicity, UK country of residence, cohabitation, educational qualifications, working hours, furlough, subjective financial difficulty and previous health condition. In the adjusted Model 1, pre-pandemic, odds of GHQ-12 caseness were lower for mothers compared to non-mothers (OR:0.89 95%CI:0.77,1.03). However post-pandemic compared to pre-pandemic, odds for mothers were higher than non-mothers, especially during lockdown 3 (Non-mothers: OR:1.93 95%CI:1.69,2.20; Mothers: OR:2.87 95%CI:2.36,3.49). In Model 2, workplace size did not modify the relationship. Pre-pandemic, there was no difference in the odds of GHQ-12 caseness by workplace size; however, the differences observed in Lockdown 3 between non-mothers and mothers, are mainly attributed to differences in medium-sized enterprises (Non-mothers: OR:1.95 95%CI:1.53,2.48; Mothers: OR:3.56 95%CI:2.54,4.99). Future policies should be designed to facilitate the working lives of mothers, but especially for medium-sized enterprises as extreme uncertainty appears to affect these employees more.

Evaluating the influence of taxation and social security policies on psychological distress: A microsimulation study of the UK during the COVID-19 economic crisis.

Economic determinants are important for population health, but actionable evidence of how policies can utilise these pathways remains scarce. This study employs a microsimulation framework to evaluate the effects of taxation and social security policies on population mental health. The UK economic crisis caused by the COVID-19 pandemic provides an informative context involving an economic shock accompanied by one of the strongest discretionary fiscal responses amongst OECD countries. The analytical setup involves a dynamic, stochastic, discrete-time microsimulation model (SimPaths) projecting changes in psychological distress given predicted economic outcomes from a static tax-benefit microsimulation model (UKMOD) based on different policy scenarios. We contrast projections of psychological distress for the working-age population from 2017 to 2025 given the observed policy environment against a counterfactual scenario where pre-crisis policies remained in place. Levels of psychological distress and potential cases of common mental disorders (CMDs) were assessed with the 12-item General Health Questionnaire (GHQ-12). The UK policy response to the economic crisis is estimated to have prevented a substantial fall (over 12 percentage points, %pt) in the employment rate in 2020 and 2021. In 2020, projected psychological distress increased substantially (CMD prevalence increase >10%pt) under both the observed and the counterfactual policy scenarios. Through economic pathways, the policy response is estimated to have prevented a further 3.4%pt [95%UI 2.8%pt, 4.0%pt] increase in the prevalence of CMDs, approximately 1.2 million cases. Beyond 2021, as employment levels rapidly recovered, psychological distress returned to the pre-pandemic trend. Sustained preventative effects on poverty are estimated, with projected levels 2.1%pt [95%UI 1.8%pt, 2.5%pt] lower in 2025 than in the absence of the observed policy response. The study shows that policies protecting employment during an economic crisis are effective in preventing short-term mental health losses and have lasting effects on poverty levels. This preventative effect has substantial public health benefits.

Comparing population-level mental health of UK workers before and during the COVID-19 pandemic: a longitudinal study using Understanding Society.

OBJECTIVES: The COVID-19 pandemic has substantially affected workers' mental health. We investigated changes in UK workers' mental health by industry, socioeconomic class and occupation and differential effects by UK country of residence, gender and age. METHODS: We used representative Understanding Society data from 6474 adults (41 207 observations) in paid employment who participated in pre-pandemic (2017-2020) and at least one COVID-19 survey. The outcome was General Health Questionnaire-12 (GHQ-12) caseness (score: ≥4). Exposures were industry, socioeconomic class and occupation and are examined separately. Mixed-effects logistic regression was used to estimate relative (OR) and absolute (%) increases in distress before and during pandemic. Differential effects were investigated for UK countries of residence (non-England/England), gender (male/female) and age (younger/older) using three-way interaction effects. RESULTS: GHQ-12 caseness increased in relative terms most for 'professional, scientific and technical' (OR: 3.15, 95% CI 2.17 to 4.59) industry in the pandemic versus pre-pandemic period. Absolute risk increased most in 'hospitality' (+11.4%). For socioeconomic class, 'small employers/self-employed' were most affected in relative and absolute terms (OR: 3.24, 95% CI 2.28 to 4.63; +10.3%). Across occupations, 'sales and customer service' (OR: 3.01, 95% CI 1.61 to 5.62; +10.7%) had the greatest increase. Analysis with three-way interactions showed considerable gender differences, while for UK country of residence and age results are mixed. CONCLUSIONS: GHQ-12 caseness increases during the pandemic were concentrated among 'professional and technical' and 'hospitality' industries and 'small employers/self-employed' and 'sales and customers service' workers. Female workers often exhibited greater differences in risk by industry and occupation. Policies supporting these industries and groups are needed.

Which is most important for mental health: Money, poverty, or paid work? A fixed-effects analysis of the UK Household Longitudinal Study.

BACKGROUND: The relative importance of income, poverty and unemployment status for mental health is unclear, and understanding this has implications for income and welfare policy design. We aimed to assess the association between changes in these exposures and mental health. METHODS: We measured effects of three transition exposures between waves of the UK Household Longitudinal Study from 2010/11-2019/20 (n=38,697, obs=173,859): income decreases/increases, moving in/out of poverty, and job losses/gains. The outcome was General Health Questionnaire (GHQ), which measures likelihood of common mental disorder (CMD) as a continuous (GHQ-36) and binary measure (score ≥4 = case). We used fixed-effects linear and linear probability models to adjust for time invariant and time-varying confounders. To investigate effect modification, we stratified analyses by age, sex and highest education. RESULTS: A 10% income decrease/increase was associated with a 0.02% increase (95% CI 0.00, 0.04) and 0.01% reduction (95% CI -0.03, 0.02) in likelihood of CMD respectively. Effect sizes were larger for moving into poverty (+1.8% [0.2, 3.5]), out of poverty (-1.8%, [-3.2, -0.3]), job loss (+15.8%, [13.6, 18.0]) and job gain (-11.4%, [-14.4, -8.4]). The effect of new poverty was greater for women (+2.3% [0.8, 3.9] versus +1.2% [-1.1, 3.5] for men) but the opposite was true for job loss (+17.8% [14.4, 21.2] for men versus +13.5% [9.8, 17.2] for women). There were no clear differences by age, but those with least education experienced the largest effects from poverty transitions, especially moving out of poverty (-2.9%, [-5.7, -0.0]). CONCLUSIONS: Moving into unemployment was most strongly associated with CMD, with poverty also important but income effects generally much smaller. Men appear most sensitive to employment transitions, but poverty may have larger impacts on women and those with least education. As the COVID-19 pandemic recedes, minimising unemployment as well as poverty is crucial for population mental health.

Educational Attainment and Gender Differences in Work-Life Balance for Couples across Europe: A Contextual Perspective.

The current article aims to explain the interrelationships between the educational attainment of individuals living in house-holds with heterosexual partners, their work-life balance (WLB) and the macro-economic climate of the country they live in, using data from the European Social Survey. WLB is a complex concept, as it is not only determined by factors related to someone's employment or domestic work and childcare responsibilities, but also by decisions informed by personal experiences and circumstances, subjective perceptions and preferences. Moreover, in households with cohabiting partners, this decision-making process involves certain compromises where financial incentives, interests, gender and power dynamics play an important role. Since educational attainment is positively related to labour market outcomes, such as employment and wages, while at the same time more women are participating in education and the labour market, the gender conflict on the division of work and time within households intensifies and traditional gender roles are challenged. WLB is at the heart of this conflict operating as a mechanism through which division of work and time is reconciled on the individual and household level. Results from the current article reveal great heterogeneity between the 17 European countries examined. Perhaps surprisingly, educational attainment can have a detrimental effect on the WLB of spouses and cohabiting partners, especially for women whose level of WLB seems also more sensitive to fluctuations of the macro-economic climate of the country they live in. However, there is an indication that when an economy goes into recession, higher education has a cushioning effect on female's WLB compared to relatively better economic times.