Precarious employment and mental health in the United States: Results from the Medical Expenditure Panel Survey (MEPS), 2008-2021.

OBJECTIVES: To measure associations between employment precarity and mental health among United States (US) workers. METHODS: This study used data from the US Medical Expenditure Panel Survey for 2008-2021. Multivariable generalized estimating equations were used to measure associations between employment precarity (operationalized as a multi-dimensional exposure) and self-rated mental health after adjusting for relevant confounders. Marginal effects analysis was used to assess potential dose-response relationships between precarity and mental health. RESULTS: Our sample (n = 57,529) was representative of >106 million US workers employed throughout 2008-2021. Compared to those with low levels of employment precarity, those with medium and high levels of precarity had an increased odds of reporting poor/fair mental health (aOR = 1.21; 95% CI = 1.11, 1.32 and 1.51; 95% CI = 1.36, 1.68, respectively). Marginal effects analysis indicated that increasing levels of precarity were associated with an increased probability of reporting poor/fair mental health. CONCLUSIONS: Increasing levels of employment precarity were associated with poor/fair self-rated mental health, findings potentially indicative of a dose-response relationship between the two. These nationally representative findings suggest employment precarity is an important social determinant of mental health. Future research could investigate how best to mitigate the negative effects of precarity on workers' lives and well-being, particularly regarding mental health.

Precarious employment in young adulthood and later alcohol-related morbidity: a register-based cohort study.

OBJECTIVES: The prevalence of precarious employment is increasing, particularly among young adults where less is known about the long-term health consequences. The present study aims to test if being precariously employed in young adulthood is associated with an increased risk of alcohol-related morbidity later in life. METHODS: A register-based cohort study was conducted in Sweden. The Swedish Work, Illness, and Labor-market Participation (SWIP) cohort was used to identify individuals who were aged 27 years between 2000 and 2003 (n=339 403). Information on labour market position (precarious employment, long-term unemployment, substandard employment and standard employment relations) was collected for young people 3 years after graduation from school using nationwide registers. Details about alcohol-related morbidity during a 28-year follow-up period were collected from the National Hospital Discharge Register. Data on sex, age, country of birth, education and previous poor health were also obtained from the registers. RESULTS: Young adults in precarious employment had an increased risk of alcohol-related morbidity compared with individuals of the same age in standard employment (HR 1.43, 95% CI 1.32 to 1.55), after adjusting for several important covariates. A stronger association was found among young men who were precariously employed compared with young women. CONCLUSION: This nationwide register-based study conducted in Sweden with a long-term follow-up suggests that being precariously employed in young adulthood is associated with an increased risk of alcohol-related morbidity later in life.

Association between temporary employment and current smoking and change in smoking behaviors: A prospective cohort study from South Korea (2009-2018).

Background Previous studies have suggested that employment insecurity is associated with adverse health outcomes. We explored the association between temporary employment and smoking behaviors.Methods We analyzed 11,795 workers (51,867 observations) from the Korea Health Panel Study (2009-2018). Employment types were categorized as regular, fixed-term, or daily, based on the duration of labor contract. The outcomes were current smoking status and changes in smoking behavior (initiation or cessation) in the following year. Generalized estimating equations were used to estimate odds ratio (OR) and 95% confidence interval (CI).Results The proportions of fixed-term and daily workers were 41.2% and 16.4% for women and 23.6% and 12.4% for men, respectively. Temporary employment was associated with increased odds of current smoking, while also demonstrating prospective associations with changes in smoking behaviors. For instance, in prospective analyses, male workers with fixed-term and daily employments were associated with a decreased likelihood of smoking cessation (OR:0.77; 95% CI:0.65-0.91 for fixed-term employment and OR:0.66; 95% CI:0.52-0.83 for daily employment) in the following year compared to those with regular employment. Moreover, those experiencing consecutive temporary employment was most inversely associated with smoking cessation in both men (OR:0.56; 95% CI:0.44-0.71) and women (OR:0.37; 95% CI:0.16-0.85) compared to those experiencing consecutive regular employment. However, no clear association between temporary employment and smoking initiation was observed in both men and women.Conclusions Temporary employment is directly associated with current smoking and inversely associated with smoking cessation. Policies are needed to improve job insecurity among temporary employees.

Precarious work on the rise.

Precarious employment (PE) is non-standard employment with uncertain and unstable contract duration, low wages, and limited labour protections and rights. Research has associated PE with workers' poor mental health and well-being; however, this association has been studied primarily using quantitative methods. This qualitative study seeks to examine the mechanisms between PE and mental health in the context of the COVID-19 pandemic in Ontario, Canada. Specifically, it aims to address: (Benach J, Muntaner C. Precarious employment and health: developing a research agenda. J Epidemiol Community Health. 2007;61(4):276.) How do PE and working conditions impact the mental well-being of workers and members of their close families or households?; and (Kreshpaj B, Orellana C, Burström B, Davis L, Hemmingsson T, Johansson G, et al. What is precarious employment? A systematic review of definitions and operationalizations from quantitative and qualitative studies. Scand J Work Environ Health. 2020;46(3):235-47.) How has the COVID-19 pandemic shaped these relationships? Semi-structured interviews were conducted with a sample of 40 individuals aged 25-55 engaged in PE during the first wave of the COVID-19 pandemic or whose employment was terminated due to the pandemic. Results showed that PE amplified mental health symptoms and illnesses for workers and their families. These experiences were described as chronic, where impacts were exerted on precariously employed workers through systemic discrimination and racism, colonialism, workplace hierarchies, and gendered ideologies. PE negatively impacted mental health through emotional stress about employment and income instability, insecurity, and loss; added pressure for households where both partners are engaged in PE; impacted ability to maintain or improve overall health and well-being; and barriers to social connectedness. Overall, this study characterizes multiple dimensions of PE and the consequences they have on the mental health of workers and their families.

Precarious employment and mental health in the Belgian service voucher system: the role of working conditions and perceived financial strain.

INTRODUCTION: Jobs in domestic cleaning are often conceived as 'precarious employment' (PE)-i.e. a multidimensional concept referring to accumulated adverse characteristics of employment due to workers' weak bargaining position. Against this background, the Belgian service voucher system (SVS) was implemented aimed at creating formal and stable, subsidized domestic services jobs. PURPOSE: The current study assesses the relationship between PE and mental health (WHO5) in the Belgian SVS, accounting for the potential mediating role of working conditions and perceived financial strain at the household level. METHODS: We analysed a cross-sectional sample of 1,115 Belgian SVS domestic cleaners, collected in 2019 through an online survey. A mediation model was estimated. RESULTS: The crude effect of PE on adverse mental health was strong (ß 0.545-S.E. 0.063). However, 50% of the association between PE and mental well-being was mediated by work task characteristics (quantitative demands, physical demands, task variation and autonomy) and 25% by household-level perceived financial strain. The remaining direct effect of PE on adverse mental well-being is ß 0.066 (S.E. 0.032-25% of the total effect). CONCLUSION: These findings are the first based on the Belgian Employment Precariousness Scale (EPRES-BE) and are consistent with earlier-made-but seldom simultaneously tested-assumptions on the mechanisms relating PE to adverse mental health-i.e. involving direct associations and indirect associations via adverse working conditions and material deprivation. Based on the results, we recommend more democratic and higher-quality management practices in the SVS, in addition to higher wages and working time reduction.

The relationships between precarious employment, having a calling, and occupational well-being among young nurses: a cross-sectional study.

BACKGROUND: Working in the healthcare sector seems less interesting than other sectors: the salary is low relative to the demands of the labour involved, and working conditions as well as management are perceived as poor. These factors may have an impact on the well-being of nurses in the healthcare sector. This study aims to explore the relationship between precarious employment and occupational well-being, in addition to the moderating effect of having a calling in this relationship among younger and older nurses. METHODS: Cross-sectional survey data were collected among Finnish nurses (n = 5867) between October and November 2020. Data were collected on demographics, occupational well-being, precarious employment, and having a calling in the field. Multiple linear regression analyses were used to explore the associations. RESULTS: Younger nurses perceived lower levels of occupational well-being and calling, and higher levels of precarious employment compared to older nurses. Precarious employment had a negative relationship with occupational well-being, and having a calling showed a positive relationship with regard to occupational well-being. No interaction effect of precarious employment and having a calling with occupational well-being was found. CONCLUSIONS: Young nurses' occupational well-being, precarious employment, and calling should be studied further because they are in a weaker position in working life. Using a qualitative approach should be considered in order to obtain more in-depth information.

" full of opportunities, but not for everyone": A narrative inquiry into mechanisms of labor market inequity among precariously employed gay, bisexual, and queer men.

BACKGROUND: This study brings lesbian, gay, bisexual, transgender (trans), and queer (LGBTQ+) populations into scholarly discourse related to precarious employment through a political economy of queer struggle. METHODS: Drawing on narrative inquiry, 20 gay, bisexual, and queer men shared stories of precarious employment that were analyzed using Polkinghorne's narrative analysis. RESULTS: Results tell an overarching narrative in three parts that follow the trajectory of participants' early life experiences, entering the labor market and being precariously employed. Part 1: Devaluation of LGBTQ+ identities and adverse life experiences impacted participants' abilities to plan their careers and complete postsecondary education. Part 2: Participants experienced restricted opportunities due to safety concerns and learned to navigate white, cis, straight, Canadian ideals that are valued in the labor market. Part 3: Participants were without protections to respond to hostile treatment for fear of losing their employment. CONCLUSIONS: These stories of precarious employment illustrate unique ways that LGBTQ+ people might be particularly susceptible to exploitative labor markets.

What is the impact of job precariousness on depression? Risk assessment and attributable fraction in Spain.

OBJECTIVES: The prevalence of depression related to precarious employment (PE) has become a significant public health concern, given the declining trend of the standard employment relationship. Research has focused on the mental health detrimental effects of employment conditions, whereas there is scarce evidence concerning the burden of depression that could be prevented by targeting precariousness. This paper estimates the impact of PE on the risk of depression and the attributable fraction within the active and working salaried population in Spain. STUDY DESIGN: Observational cross-sectional on data drawn from the Spanish portion of European Health Survey 2020. METHODS: After applying selection criteria and descriptives, binary logistic regression models stratified by sex are used to examine the associations between a 9-categories combination of employment precariousness and occupational social class, and depressive symptoms. RESULTS: There is a higher risk of depression among individuals in PE and among those who are unemployed, with a notable gradient based on occupational social class for women. Adjusting by sex, age and foreign-born origin, we estimate that approximately 15.0% (95% confidence interval [CI]: 1.0%-26.2%) of depression cases among the working population and 33.3% (95% CI: 23.2%-43.2) among the active population can be attributed to PE. CONCLUSIONS: These findings highlight the public health impact of PE on mental health, provide evidence to estimate the economic burden linked to employment-related mental health, and underscore the need for policy changes and interventions at the level of labour markets and workplaces to mitigate the detrimental effects of PE.

The impact of precarious employment on the commitment of registered nurses.

AIM: To investigate the association between precarious employment and commitment among registered nurses. BACKGROUND: The nursing profession faces numerous challenges, and precarious employment (PE) has emerged as a significant issue affecting nurses' well-being and professional status. METHODS: In spring 2023, we conducted a cross-sectional survey involving members of a healthcare workers' trade union in Finland. The study encompassed data from 2,370 registered nurses representing various healthcare sectors nationwide. Regression analysis was used to explore the relationship between PE and nurses' commitment. STROBE guidelines were used to report the study. RESULTS: The modified PE scale demonstrated a good fit. Among the various dimensions of PE, nurses perceived the highest level of precariousness in terms of inadequate training opportunities, followed by unpredictable and nonstandard working hours, low wages, and disempowerment. Vulnerability arising from authoritarian management exhibited the most significant and negative association with nurses' commitment (B = -0.233). DISCUSSION: The findings of this study underscore that PE is a pressing concern within the nursing profession, and it has a detrimental impact on nurses' commitment. While precariousness in nursing is associated with issues related to empowerment and fair leadership, it appears that conventional challenges related to working hours, typical of the nursing profession, do not significantly affect nurses' commitment. IMPLICATIONS FOR NURSING AND NURSING POLICY: To enhance nurses' commitment, healthcare institutions and managers must actively promote leadership practices that empower and support employees. Also, employees' legal work-related rights have to be respected in organizations. Addressing these aspects can contribute to a more resilient and dedicated nursing workforce.

"When there is no money, that is when I vomit blood": the domino effect and the unfettered lethal exploitation of Black labor on Dominican sugar plantations.

BACKGROUND: In this article, I utilize the concept of the Plantationocene as an analytical framework to generate a holistic and historical understanding of the present-day struggles of a mostly Haitian migrant workforce on sugar plantations in the Dominican Republic. METHODS: Inspired by Paul Farmer's methodology, I combine political economy, history, and ethnography approaches to interpret the experiences of sugarcane cutters across historical and contemporary iterations of colonial, post-colonial, and neo-colonial practices over the course of five centuries. RESULTS: My findings elucidate the enduring power of capitalism, implicating corporate and state elites, as the structural scaffolding for acts of racialized violence that condition the life-and-death circumstances of Black laborers on Caribbean plantations to this day. Although today's sugarcane cutters may suffer differently than their enslaved or wage labor ancestors on the plantation, I argue that an unfettered racialized pattern of lethal exploitation is sustained through the structural violence of neoliberalism that links present conditions with the colonial past. CONCLUSIONS: Ultimately, this paper contributes understandings of the plantationocene's enduring effects in the global south by demonstrating how imperialist arrangements of capitalism are not a distant memory from the colonial past but instead are present yet hidden and obscured while relocated and reanimated overseas to countries like the Dominican Republic, where American capitalists still exploit Black bodies for profit and power.

To what extent do job insecurity, income satisfaction, and self-rated health mediate the association between low income and presenteeism in Germany? A gendered analysis.

PURPOSE: Low income is considered a possible determinant of presenteeism, explained by poor working and living conditions, increased levels of uncertainties and anxiety, and poor health status. We aimed to examine the association between low income and presenteeism by gender and to explain their association using different mediators. METHODS: A total of 14,299 employees aged 18-65 from the 6th BIBB/BAuA Employment Survey 2012 were used, and mediation analyses with inverse odds weighting stratified by gender were conducted. RESULTS: Low income was significantly associated with presenteeism for men at a significant level of α < .05 (ß: 0.376; 95%-CI 0.148-0.604) and for women at a significant level of α < .10 (ß: 0.120; 95%-CI - 0.015-0.255). The total effect (TE) was fully and significantly mediated for women when all mediator-weights were considered, whereas for men the consideration of single mediator-weights led to a full and significant mediation of the association between low income and presenteeism. Self-rated health status and income satisfaction contributed the most to the differences in presenteeism by low income with a proportion mediated of 96.3% (men) and 169.2% (women) for self-rated health and 101.6% (men) and 162.5% (women) for income satisfaction. DISCUSSION: The results indicated a strong association between low income and presenteeism, in particular for men. Self-rated health and income satisfaction were the most important mediators of this association. The results underline not only the relevance of occupational health management and preventive measures, but also the need of a public debate about employment traditions, possibly resulting in role conflicts among men, and wage equality to prevent presenteeism of low-income earners.

Employment trajectories and mental health-related disability in Belgium.

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

The effects of precarious employment and calling on the psychosocial health and work well-being of young and older workers in the care sector: a longitudinal study.

OBJECTIVE: Employment conditions in the care sector are changing, and precarious employment (PE) is becoming more widespread, manifesting as undervaluation, adverse leadership, work overload, and inadequate control over work. This study aimed to examine changes in psychosocial health, work well-being, PE, and calling over time and explore the effects of PE and calling on psychosocial health and work well-being. METHODS: The longitudinal study collected follow-up panel data in the three time points (2020, 2022, and 2023) from care workers (n = 1502), linear mixed effects models. RESULTS: PE decreased (ß = - 0.02), and perceived work well-being increased (ß = 0.04), but there were no change in psychosocial health (ß = - 0.01) and calling (ß = 0.01) during the three-year period. Younger (< 39) care workers perceived higher levels of PE and had poorer psychological health. Moreover, PE had a negative effect on psychosocial health (ß = - 0.63) and work well-being (ß = - 0.68) and calling had a positive effect on psychosocial health (ß = 0.41) and work well-being (ß = 0.49) in multivariate models. CONCLUSION: PE conditions affect work performance and employee well-being and may threaten patient care; therefore, it should be further investigated in the care sector. It is noteworthy that calling still seems to be central in care work. The results deepen the understanding of the current shortage crisis in health and social care workplaces but can also provide keys to resolving the crisis.

Increased risk of sleep problems according to employment precariousness among paid employees in Korea.

BACKGROUND: This study aimed to investigate the relationship between precarious employment (PE) and sleep problems among wage workers in Korea. METHODS: Data from 29,437 wage workers were obtained from the 6th Korean Working Conditions Survey. PE was defined based on four dimensions: employment temporariness, irregularity, lack of protection, and economic vulnerability. A PE index indicating employment precariousness was derived. The outcome variables were three sleep problems experienced over the past year: difficulty initiating asleep; difficulty maintaining sleep' and fatigue upon waking. Multiple logistic regression was performed after adjusting for age, educational level, occupation, job tenure, company size, and working hours, to estimate the association between PE and sleep problems. RESULTS: For both sexes, the risk of all sleep problems significantly increased as the precariousness of employment increased, showing a dose-response relationship. CONCLUSION: An increased risk of sleep problems is evident as employment becomes more precarious. These findings could help improve the health of workers with PE by addressing sleep problems.

A tutorial on a marginal structural modeling approach to mediation analysis in occupational health research: Investigating education, employment quality, and mortality.

Life expectancy inequities between more- and less-educated groups have grown by 1 to 2 years over the last several decades in the United States. Simultaneously, employment conditions for many workers have deteriorated. Researchers hypothesize that these adverse conditions mediate educational inequities in mortality. However, methodological barriers have impeded research on the role of employment conditions and other hazards as mediating factors in health inequities. Indeed, traditional mediation analysis methods are often biased in occupational health settings, including in those with exposure-mediator interactions and mediator-outcome confounders that are caused by exposure. In this paper, we outline-and provide code for-a marginal structural modeling (MSM) approach for estimating total effects and controlled direct effects originally proposed elsewhere, which can be applied to common mediation analysis settings in occupational health research. As an example, we apply our approach to assess the extent to which disparities in employment quality (EQ)-a multidimensional construct characterizing the terms and conditions of the worker-employer relationship-explained educational inequities in mortality in a 1999-2015 US Panel Study of Income Dynamics sample of workers with mortality follow-up through 2017. Under certain strong assumptions described in the text, our estimates suggest that over 70% of the educational inequity in mortality would have been eliminated if EQ had been at the 80th percentile (100th = best) across exposure groups.

The Employment Quality of Persons with Disabilities: Findings from a National Survey.

PURPOSE: Labour market integration is a widely accepted strategy for promoting the social and economic inclusion of persons with disabilities. But what kinds of jobs do persons with disabilities obtain following their integration into the labour market? In this study, we use a novel survey of workers to describe and compare the employment quality of persons with and without disabilities in Canada. METHODS: We administered an online, cross-sectional survey to a heterogeneous sample of workers in Canada (n = 2,794). We collected data on sixteen different employment conditions (e.g., temporary contract, job security, flexible work schedule, job lock, skill match, training opportunities, and union membership). We used latent class cluster analysis to construct a novel typology of employment quality describing four distinct 'types' of employment: standard, portfolio, instrumental, and precarious. We examined associations between disability status, disability type, and employment quality. RESULTS: Persons with disabilities reported consistently lower employment quality than their counterparts without disabilities. Persons with disabilities were nearly twice as likely to report low-quality employment in the form of either instrumental (i.e., secure but trapped) or precarious (i.e., insecure and unrewarding) employment. This gap in employment quality was particularly pronounced for those who reported living with both a physical and mental/cognitive condition. CONCLUSION: There are widespread inequalities in the employment quality of persons with and without disabilities in Canada. Policies and programs aiming to improve the labour market situation of persons with disabilities should emphasize the importance of high-quality employment as a key facet of social and economic inclusion.

"I grabbed my stuff and walked out": Precarious workers' responses and next steps when faced with procedural unfairness during work injury and claims processes.

PURPOSE: Injured workers can experience adverse effects from work injury and claims processes.Workers may be treated unfairly by employers, compensation boards, and return-to-work coordinators; however,how workers respond to these challenges is unknown. This article describes how injured precarious workersresponded behaviourally and emotionally to procedural unfairness in work injury and claims processes, and whatworkers did next. METHODS: Interviews were conducted with thirty-six precariously employedinjured workers recruited in Ontario through social media, email, cold calling, word-of-mouth, and the "snowball"method. Thematic code summaries were analyzed to identify how precarious workers responded to procedural unfairness. RESULTS: Workers went through all or most of these five stages (not always linearly)when faced with procedural unfairness: (1) passive, (2) fought back, (3) quit pursuit of claim, (4) quit job, and (5)won or got further in fight. Feeling confused, angry, frustrated, unsupported, disappointed, determined, optimistic,and wary were common emotions. CONCLUSIONS: Identifying unfairness and its emotional,behavioral, and material effects on workers is important to understand implications for compensation systems.Understanding and recognizing unfairness can equip employers, legal representatives, compensation boards, andphysicians, to address and prevent it, and provide worker resources. Policy changes can ensure accountability andconsequences to unfairness initiators.

[Working poverty and self-rated health during the COVID-19 pandemic: a comparative study over time using 1995-2021 Socioeconomic Panel data]. / Erwerbsarmut und subjektive Gesundheit während der COVID-19-Pandemie: Eine Zeitvergleichsstudie mit Daten des Sozio-oekonomischen Panels 1995­2021.

BACKGROUND: The working poor are considered a vulnerable group. This study examines whether health disparities between working-poor and non-working-poor workers have worsened in the wake of the COVID-19 pandemic by comparing them over time with earlier periods of economic crisis and social and labor market policy reform. METHODS: The analyses are based on the Socioeconomic Panel (SOEP, 1995-2020) and the Special Survey on Socioeconomic Factors and Consequences of the Spread of Coronavirus in Germany (SOEP-CoV, 2020-2021). All employed persons aged 18-67 years were considered for the analyses to calculate the risks of poor subjective health due to working poverty using pooled logistic regression by sex. RESULTS: Subjective health improved during the COVID-19 pandemic. Differences in health between the working poor and those who were not working poor remained relatively constant between 1995 and 2021. Individuals who were more likely to be in working poverty over time had the highest risk of inadequate health. The health disparities associated with the frequency of working poverty increased over time and peaked for both sexes in the pandemic. Significant sex differences were not identified. DISCUSSION: This study illustrates the social embeddedness of working poverty as a determinant of poor health. In particular, those who were more likely to experience working poverty during their working lives are considered to be particularly vulnerable to inadequate health. Tendentially, the COVID-19 pandemic appears to reinforce this gradient in health.

Precarious Employment and Well-Being: Insights from the COVID-19 Pandemic.

While precarious employment is not a new concept, it has been brought to the center of scholarly and public discourse worldwide by the unprecedented COVID-19 pandemic. This essay delineates how precarious employment shapes well-being and situates that relationship in the context of the COVID-19 pandemic. The essay also provides an overview of how the nine articles boldly investigate how these two layers of global risk-precarious employment and the pandemic-interact to shape individuals' well-being. In addition to advancing theoretical and empirical knowledge by analyzing timely data from diverse sources and populations, these articles call for more efforts on worker protection reforms and government financial support.

The effects of pregnancy discrimination on postpartum depressive symptoms: a follow-up study.

BACKGROUND: Pregnancy discrimination in the workplace is prevalent worldwide. However, few studies have examined the effects of pregnancy discrimination on mothers' perinatal mental health. We aimed to investigate the association between pregnancy discrimination and postpartum depressive symptoms, and the mediation effects of prenatal depressive symptoms on this association. METHODS: Our sample consisted of 285 Japanese women employed during pregnancy who completed a baseline online survey in May 2020 and a follow-up mail survey two months postpartum. Pregnancy discrimination was defined as exposure to any of 16 forms of disadvantageous treatment or harassment related to pregnancy, prohibited by national guidelines. Prenatal (assessed at baseline) and postpartum (assessed at follow-up) depressive symptoms were measured using the Edinburgh Postnatal Depression Scale. Multiple linear regression and mediation analyses were performed overall and stratified by regular (permanent) and non-regular (precarious) employees. RESULTS: Overall, 23.9% of participants experienced pregnancy discrimination during pregnancy. After adjusting for potential confounders, pregnancy discrimination was significantly associated with postpartum depressive symptoms (coefficient 1.76, 95% confidence interval [CI] 0.65-2.88). When stratified by employment type, these effects were observable among non-regular employees (coefficient 2.51, 95% CI 0.45-4.57) but not regular employees. Mediation analysis showed that prenatal depressive symptoms mediated 57.1% (95% CI 20.1-94.1%) of the association between pregnancy discrimination and postpartum depressive symptoms among all participants, with a greater effect among non-regular employees (64.1% [95% CI 18.5-109.8%]). CONCLUSIONS: Pregnancy discrimination has adverse effects on postpartum depressive symptoms, partially through prenatal depressive symptoms, especially among non-regular employees. To prevent perinatal depression in female workers, employers should comply with legislation and take preventive measures against pregnancy discrimination, while considering vulnerable employees.