The gendered associations between precarious employment and mental health in working-age Australians: A longitudinal analysis using 16 waves of the HILDA survey.

Unemployment and precarious employment (PE) are routinely found to be associated with poorer mental health. Importantly, women are over-represented in PE (due to disproportionate unpaid care demands), yet a gender lens has been lacking in much of the extant literature. This study addresses several gaps by reconsidering how PE can be conceptualised from a gender perspective and examining the impact of differing levels of multidimensional PE on the mental health of working-age Australians. Utilising sixteen annual waves (2005-2020) of the HILDA survey, this longitudinal study employed mixed-effects analysis and Mundlak modelling to examine the association between PE and mental health in working-age (25-64yrs) adults. Mental health was assessed using the MHI-5 scale. A multidimensional PE scale (based on objective and subjective indicators) was developed and three levels of precarity were modelled. 19,442 participants were included in the analyses and all models were stratified by gender. We found women experience greater exposure to PE in Australia, and our results showed a ubiquitously strong and negative association between PE and mental health in both women and men, across all levels of PE, with a dose dependent association observed with increasing PE. Additional adjustment for prior mental health slightly attenuated effect sizes, but the strength and direction of all associations were unchanged. This study provides longitudinal evidence of the detrimental impact of PE on the mental health of working age Australians, highlighting the importance of labour regulations and employment policies to minimize PE for all adults. However, given women's differential exposure to PE, this study also reinforces the urgent need for gender-sensitive social policies to address continued inequity in the division of unpaid household labour to promote a more equitable paid labour market into the future.

Time use, time pressure and sleep: is gender an effect modifier?

BACKGROUND: The gendered division of labour contributes to differences in the way time is spent and experienced by women and men. Time spent in paid and unpaid labour is associated with sleep outcomes, therefore, we examined (i) the relationships between time use and time pressure, and sleep, and (ii) whether these relationships were modified by gender. METHODS: Adults from the Household Income and Labour Dynamics in Australia survey were included in the analysis (N = 7611). Two measures of time use (total time commitments, ≥50% of time spent in paid work) were calculated based on estimates of time spent in different activities. One measure of time pressure was also included. Three sleep outcomes (quality, duration and difficulties) were examined. Logistic regression and effect measure modification analyses were employed. RESULTS: Total time commitments were associated with sleep duration, whereby more hours of total time commitments were associated with an increase in the odds of reporting <7 h sleep. Gender was an effect modifier of the association between ≥50% of time spent in paid work and (i) sleep duration on the multiplicative scale, and (ii) sleep difficulties on the multiplicative and additive scales. Men who spent <50% of time in paid work reported more sleep difficulties than men who spent ≥50% of time spent in paid work. Feeling time pressured was associated with poor sleep quality, short sleep duration and sleep difficulties. CONCLUSIONS: Time use and time pressure were associated with sleep, with some effects experienced differently for men and women.

The association between unpaid labour and mental health in working-age adults in Australia from 2002 to 2020: a longitudinal population-based cohort study.

BACKGROUND: Unpaid labour is a daily part of most people's lives, none more so than for women. Yet, in comparison to paid work, the effect of unpaid labour on mental health is an under-researched area. This study aims to address key gaps in the extant literature, examining how unpaid labour is associated with mental health in working-age men and women, and whether gender differences exist. METHODS: In this longitudinal population-based cohort study, 19 waves of the Household, Income, and Labour Dynamics in Australia (HILDA) survey were used to employ a fixed effects regression analysis to examine the associations between unpaid labour and mental health in working-age (aged 25-64 years) Australian adults. Mental health was assessed using the MHI-5 scale. Both the individual and the combined effects of four different domains of unpaid labour (household work, childcare, care for adults, and outdoor tasks) were interrogated, as were the gender differences. FINDINGS: Of the 37 352 participants (297 036 observations) in waves 2002-20 of the HILDA Survey, 22 832 people (190 207 observations) were aged 25-64 years, and after excluding participants with missing data, 21 014 participants (150 163 observations) were included in the analysis. Increasing time in household work was negatively associated with mental health in both men (ß coefficient=-0·026 [95% CI -0·04 to -0·01]) and women (ß coefficient=-0·009 [-0·02 to 0·001]), as was care for adults (disabled or older people) in women (ß coefficient=-0·027 [-0·04 to -0·01]). Conversely, increasing time in childcare for women (ß coefficient=0·016 [0·01 to 0·02]) and outdoor tasks for men, was positively associated with mental health (ß coefficient=0·067 [0·04 to 0·09]). A null finding for the overall cumulative total unpaid labour exposure for both men and women was probably attributable to the opposing direction of effects between the individual domains that constituted the total load. INTERPRETATION: This study reveals considerable variance and nuance in how different domains of unpaid labour affect mental health, as well as continued inequity in the division of unpaid labour in households, with women doing considerably more unpaid labour than men. This study also exposes important challenges associated with measuring and understanding total (combined) unpaid labour as a determinant of health. FUNDING: University of Melbourne Research Training Scholarship, Australian Research Council Discovery Early Career Award, Australian Research Council Linkage Project.

Gender differences in the association between unpaid labour and mental health in employed adults: a systematic review.

Globally, billions of hours are spent on unpaid labour every year, a burden that is disproportionately carried by women. However, the potential health effects of unpaid labour have largely been unexplored. This Review examines the gendered association between unpaid labour and mental health among employed adults. We did a search of six databases and examined the association between different forms of unpaid labour and mental health. 19 studies (totalling 70 310 participants) were included. We found substantial heterogeneity, and low-to-moderate methodological quality, in the existing research. Our Review indicates substantial gender differences in exposure to unpaid labour and confirms persistent inequities in the division of unpaid work. Overall, our findings indicate that, among employed adults, unpaid labour is negatively associated with women's mental health, with effects less apparent for men. Globally, women spend a greater number of hours on unpaid labour; this review suggests that inequities in the division of unpaid labour expose women to greater risk of poorer mental health than men.

Reciprocal relationships between time pressure and mental or physical health in Australian mothers of preschool aged children.

The associations between time pressure and health are typically conceptualised and examined as unidirectional. This study examined the reciprocal relationships between time pressure and mental and physical health amongst working mothers of preschool children; a high-risk group for feeling time pressured. Using 5 waves of a panel study of Australian mothers when their children were aged 0-4 (n = 3878) and cross-lagged structural equation models, we find strong significant negative reciprocal associations between time pressure and mental and physical health, although these reciprocal associations were stronger and more consistent over time for mental health. Our results indicate that physical health takes a couple of years to deteriorate to a point where the reciprocal effects with time pressure become apparent, but for mental health the reciprocal effects are immediate, present at all time points and consistently strong. Findings suggest there are significant reciprocal health consequences of the time pressure experienced by working mothers and government policy encouraging mothers back into the workforce without adequate supports may be harmful for health.

The consequences of household composition and household change for Indigenous health: evidence from eight waves of the Longitudinal Study of Indigenous Children (LSIC).

Households are important health contexts, providing social, emotional, financial and material support, but little is known about the role of household composition in the social etiology of Indigenous health. Our research is framed by an Indigenous standpoint, using eight waves of data from the Longitudinal Study of Indigenous Children. We investigated whether household composition and change in household composition were associated with the self-reported general health of Indigenous children and their mothers, adjusting for socioeconomic, household structure and social support factors. Our measure of household composition comprised eight groups differentiating lone and couple parents, living with and without other children and adults. Study children in couple households with other children and adults were 16% less likely to have excellent health and mothers in these same households were 7% less likely to report excellent health than children and mothers in couple households. We find little evidence that mothers in lone parent households have poorer health than mothers in couple households, after adjustment for covariates. Change in household composition was positively associated with health for both children and mothers. The results caution against presuming a direct translatability of research findings from non-Indigenous to Indigenous Peoples.

Children's sleep and fathers' health and wellbeing: A systematic review.

Night-waking is typical across infancy and early childhood, inevitably disrupting family sleep. For some children, sleep problems develop and endure throughout childhood. This systematic review focused on fathers, and synthesised the evidence pertaining to the effects of children's sleep (from birth to 12 years) on fathers' health and wellbeing. A total of 29 studies were included. Key outcomes reported for fathers were: sleep and fatigue; mental and general health; and family functioning. An association between child sleep and father's sleep was observed when child's sleep was measured via actigraphy or paternal report, but not when measured via maternal report, suggesting that mothers may not always be aware of disruptions that awaken fathers. Findings showed poorer child sleep was associated with poorer general health and wellbeing among fathers, however, associations of poor child sleep with depression were fewer, and less frequent than those reported for mothers in the same households. Poor child sleep was negatively associated with the quality of family relationships, both within the couple and between parent and child. Future studies seeking to understand the interplay of child sleep and family wellbeing should apply objective measurement of sleep and integrate formal measures of family dynamics into the study design.

Gender Equality and Health in High-Income Countries: A Systematic Review of Within-Country Indicators of Gender Equality in Relation to Health Outcomes.

Background: Gender equality is recognized as an important political, social, and economic goal in many countries around the world. At a country level, there is evidence that gender equality may have an important influence on health. Historically gender equality has mainly been measured to allow for between-country, rather than within-country comparisons; and the association between gender equality and health outcomes within countries has been under-researched. This article thus aimed to systematically review within-country indicators of gender equality in public health studies and assess the extent to which these are related to health outcomes. Materials and Methods: We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) approach with two independent reviewers. Results: Data from the eight included studies revealed that there was heterogeneity in the way gender equality has been measured as a multidimensional construct. Associations between gender equality and a number of different health outcomes were apparent, including mortality, mental health, morbidity, alcohol consumption, and intimate partner violence, with gender equality mostly associated with better health outcomes. Conclusions: Further investigation into the effects of gender equality on health outcomes, including a clear conceptualization of terms, is critical for the development of policies and programs regarding gender equality.

Do managers sleep well? The role of gender, gender empowerment and economic development.

Work demands often disrupt sleep. The stress of higher status theory posits that workers with greater resources often experience greater stress. We extend this theory to sleep and ask: do managers report more disrupted sleep and does this vary by gender and country context? Data come from the 2012 European Social Survey Programme and our sample comprised those currently employed in their prime working age (n = 27,616; age 25-64) in 29 countries. We include country level measures of the Gender Development Index (GDI) and gross domestic product (GDP). We find that workers sleep better, regardless of gender, in countries where women are empowered. For managers, women sleep better as GDI increases and men as GDP increases. Our results suggest that men experience a sleep premium from economic development and women from gender empowerment.

Shifts in gender equality and suicide: A panel study of changes over time in 87 countries.

BACKGROUND: Increasing gender equality remains an imperative for countries and organisations worldwide, and is associated with the improved life outcomes of men and women. Unlike many health and wellbeing indicators, death by suicide is more common among men, but suicidal behaviours are more common among women. Understanding of the relationship between gender equality and suicide is inchoate, and limited to cross-sectional work. We sought to address this gap by examining within-country changes in gender equality over time, in relation to suicide rates. METHODS: Data from 87 countries for the years 2006-2016 were used in this analysis. Gender Equality was measured using the Gender Gap Index (GGI), produced by the World Economic Forum. Male and female suicide rates came from the World Health Organization. Fixed and random-effects unbalanced panel regression models were used, adjusting for: GDP/capita; population; urban/rural ratio; number of children/person;% unemployed; year. Models were stratified by gender. RESULTS: Increasing within-country gender equality was associated with a significant reduction in suicide rates for women (Coef. -7.08, 95% CI -12.35 to -1.82, p = 0.009). For men, there was insufficient evidence that increasing within-country gender equality was associated with reduced within-country suicide rates (Coef. -5.76, 95% CI -19.40 to 7.86, p = 0.403). LIMITATIONS: The reporting and collection of suicide data is known to vary across countries. CONCLUSION: There is evidence that within-country increases in gender equality are associated with significant reductions in within-country suicide-rates for women. More research is needed to understand the drivers of these associations.

Do active modes of transport cause lower body mass index? Findings from the HABITAT longitudinal study.

BACKGROUND: Few studies have examined the causal relationship between transport mode and body mass index (BMI). METHODS: We examined between-person differences and within-person changes in BMI by transport mode over four time points between 2007 and 2013. Data were from the How Areas in Brisbane Influence HealTh and AcTivity project, a population-representative study of persons aged 40-65 in 2007 (baseline) residing in 200 neighbourhoods in Brisbane, Australia. The analytic sample comprised 9931 respondents who reported on their main transport for all travel purposes (work-related and non-work-related). Transport mode was measured as private motor vehicle (PMV), public transport, walking and cycling. Self-reported height and weight were used to derive BMI. Sex-specific analyses were conducted using multilevel hybrid regression before and after adjustment for time-varying and time-invariant confounders. RESULTS: Independent of transport mode and after adjustment for confounders, average BMI increased significantly and linearly across the four time points for both men and women. Men and women who walked or cycled had a significantly lower BMI than their counterparts who used a PMV. BMI was nearly always lower during the time men and women walked or cycled than when they used a PMV; however, few statistically significant differences were observed. For women, BMI was significantly higher during the time they used public transport than when using a PMV. CONCLUSION: The findings suggest a causal association between transport mode and BMI and support calls from health authorities to promote walking and cycling for transport as a way of incorporating physical activity into everyday life to reduce the risk of chronic disease.

The benefits of paid maternity leave for mothers' post-partum health and wellbeing: Evidence from an Australian evaluation.

This paper investigates the health effects of the introduction of a near universal paid parental leave (PPL) scheme in Australia, representing a natural social policy experiment. Along with gender equity and workforce engagement, a goal of the scheme (18 weeks leave at the minimum wage rate) was to enhance the health and wellbeing of mothers and babies. Although there is evidence that leave, especially paid leave, can benefit mothers' health post-partum, the potential health benefits of implementing a nationwide scheme have rarely been investigated. The data come from two cross-sectional surveys of mothers (matched on their eligibility for paid parental leave), 2347 mother's surveyed pre-PPL and 3268 post-PPL. We investigated the scheme's health benefits for mothers, and the extent this varied by pre-birth employment conditions and job characteristics. Overall, we observed better mental and physical health among mothers after the introduction of PPL, although the effects were small. Post-PPL mothers on casual (insecure) contracts before birth had significantly better mental health than their pre-PPL counterparts, suggesting that the scheme delivered health benefits to mothers who were relatively disadvantaged. However, mothers on permanent contracts and in managerial or professional occupations also had significantly better mental and physical health in the post-PPL group. These mothers were more likely to combine the Government sponsored leave with additional, paid, employer benefits, enabling a longer paid leave package post-partum. Overall, the study provides evidence that introducing paid maternity leave universally delivers health benefits to mothers. However the modest 18 week PPL provision did little to redress health inequalities.

Young maternal age at first birth and mental health later in life: Does the association vary by birth cohort?

BACKGROUND: It is well established that maternal age at childbirth has implications for women's mental health in the short term, however there has been little research regarding longer term implications and whether this association has changed over time. We investigated longer term mental health consequences for young mothers in Australia and contrasted the effects between three birth cohorts. METHODS: Using thirteen waves of data from 4262 women aged 40 years or above participating in the Household, Income and Labour Dynamics in Australia Survey, we compared the mental health of women who had their first child aged 15-19 years, 20-24 years, and 25 years and older. Mental health was measured using the mental health component summary score of the SF-36. We used random-effects linear regression models to generate estimates of the association between age at first birth and mental health, adjusted for early life socioeconomic characteristics (country of birth, parents' employment status and occupation) and later life socioeconomic characteristics (education, employment, income, housing tenure, relationship status and social support). We examined whether the association changed over time, testing for effect modification across three successive birth cohorts. RESULTS: In models adjusted for early life and later life socioeconomic characteristics, there was strong evidence of an association between teenage births and poor mental health, with mental health scores on average 2.76 to 3.96 points lower for mothers aged younger than 20 years than for mothers aged 25 years and older (Late Baby Boom (born 1936-1945): -3.96, 95% CI -5.38, -2.54; Early Baby Boom (born 1946-1955): -3.01, 95% CI -4.32, -1.69; Lucky Few (born 1956-1965): -2.76, 95% CI -4.34, -1.18), and evidence of an association for mothers aged 20-24 years compared to mothers aged 25 years and older in the most recent birth cohort only (-1.09, 95% CI -2.01, -0.17). There was some indication (though weak) that the association increased in more recent cohorts. CONCLUSION: This study highlights that young mothers, and particularly teenage mothers, are a vulnerable group at high risk of poor mental health outcomes compared to mothers aged 25 years and above, and there was some suggestion (though weak) that the health disparities increased over time.

The maternal health outcomes of paid maternity leave: a systematic review.

Paid maternity leave has become a standard benefit in many countries throughout the world. Although maternal health has been central to the rationale for paid maternity leave, no review has specifically examined the effect of paid maternity leave on maternal health. The aim of this paper is to provide a systematic review of studies that examine the association between paid maternity leave and maternal health. We conducted a comprehensive search of electronic databases (Medline, Embase, CINAHL, PsycINFO, Web of Science, Sociological Abstracts) and Google Scholar. We searched websites of relevant organisations, reference lists of key papers and journals, and citation indices for additional studies including those not in refereed journals. There were no language restrictions. Studies were included if they compared paid maternity leave versus no paid maternity leave, or different lengths of paid leave. Data were extracted and an assessment of bias was performed independently by authors. Seven studies were identified, with participants from Australia, Sweden, Norway, USA, Canada, and Lebanon. All studies used quantitative methodologies, including cohort, cross-sectional, and repeated cross-sectional designs. Outcomes included mental health and wellbeing, general health, physical wellbeing, and intimate partner violence. The four studies that examined leave at an individual level showed evidence of maternal health benefits, whereas the three studies conducting policy-level comparisons reported either no association or evidence of a negative association. The synthesis of the results suggested that paid maternity leave provided maternal health benefits, although this varied depending on the length of leave. This has important implications for public health and social policy. However, all studies were subject to confounding bias and many to reverse causation. Given the small number of studies and the methodological limitations of the evidence, longitudinal studies are needed to further clarify the effects of paid maternity leave on the health of mothers in paid employment.

Change in walking for transport: a longitudinal study of the influence of neighbourhood disadvantage and individual-level socioeconomic position in mid-aged adults.

BACKGROUND: Unlike leisure time physical activity, knowledge of the socioeconomic determinants of active transport is limited, research on this topic has produced mixed and inconsistent findings, and it remains unknown if peoples' engagement in active transport declines as they age. This longitudinal study examined relationships between neighbourhood disadvantage, individual-level socioeconomic position and walking for transport (WfT) during mid- and early old-age (40 - 70 years). Three questions were addressed: (i) which socioeconomic groups walk for transport, (ii) does the amount of walking change over time as people age, and (iii) is the change socioeconomically patterned? METHODS: The data come from the HABITAT study of physical activity, a bi-annual multilevel longitudinal survey of 11,036 residents of 200 neighbourhoods in Brisbane, Australia. At each wave (2007, 2009 and 2011) respondents estimated the duration (minutes) of WfT in the previous 7 days. Neighbourhood disadvantage was measured using a census-derived index comprising 17 different socioeconomic components, and individual-level socioeconomic position was measured using education, occupation, and household income. The data were analysed using multilevel mixed-effects logistic and linear regression. RESULTS: The odds of being defined as a 'never walker' were significantly lower for residents of disadvantaged neighbourhoods, but significantly higher for the less educated, blue collar employees, and members of lower income households. WfT declined significantly over time as people aged and the declines were more precipitous for older persons. Average minutes of WfT declined for all neighbourhoods and most socioeconomic groups; however, the declines were steeper for the retired and members of low income households. CONCLUSIONS: Designing age-friendly neighbourhoods might slow or delay age-related declines in WfT and should be a priority. Steeper declines in WfT among residents of low income households may reflect their poorer health status and the impact of adverse socioeconomic exposures over the life course. Each of these declines represents a significant challenge to public health advocates, urban designers, and planners in their attempts to keep people active and healthy in their later years of life.

The influence of neighbourhood disadvantage on smoking cessation and its contribution to inequalities in smoking status.

INTRODUCTION AND AIMS: Individual smokers from disadvantaged backgrounds are less likely to quit, which contributes to widening inequalities in smoking. Residents of disadvantaged neighbourhoods are more likely to smoke, and neighbourhood inequalities in smoking may also be widening because of neighbourhood differences in rates of cessation. This study examined the association between neighbourhood disadvantage and smoking cessation and its relationship with neighbourhood inequalities in smoking. DESIGN AND METHODS: A multilevel longitudinal study of mid-aged (40-67 years) residents (n = 6915) of Brisbane, Australia, who lived in the same neighbourhoods (n = 200) in 2007 and 2009. Neighbourhood inequalities in cessation and smoking were analysed using multilevel logistic regression and Markov chain Monte Carlo simulation. RESULTS: After adjustment for individual-level socioeconomic factors, the probability of quitting smoking between 2007 and 2009 was lower for residents of disadvantaged neighbourhoods (9.0-12.8%) than their counterparts in more advantaged neighbourhoods (20.7-22.5%). These inequalities in cessation manifested in widening inequalities in smoking: in 2007 the between-neighbourhood variance in rates of smoking was 0.242 (P ≤ 0.001) and in 2009 it was 0.260 (P ≤ 0.001). In 2007, residents of the most disadvantaged neighbourhoods were 88% (OR 1.88, 95% credible intervals (CrI) 1.41-2.49) more likely to smoke than residents in the least disadvantaged neighbourhoods: the corresponding difference in 2009 was 98% (OR 1.98, 95% CrI 1.48-2.66). CONCLUSION: Fundamentally, social and economic inequalities at the neighbourhood and individual levels cause smoking and cessation inequalities. Reducing these inequalities will require comprehensive, well-funded and targeted tobacco control efforts and equity-based policies that address the social and economic determinants of smoking.

Novel fiber optic detection method for in situ analysis of fluorescently labeled biosensor organisms.

This research presents a novel, time-resolved fiber-optic "Optrode" system for accurate real-time in situ detection of fluorescent proteins produced by biosensor organisms. The Optrode fluorescence detection system was able to identify, characterize, differentiate, and quantify red and green fluorescently labeled organisms, individually and in mixed aqueous cultures. Detection was also possible in sand systems, where a consistent reduction in signal intensity indicates that signal collection volume was reduced by one-third. The optrode was shown to be sensitive enough to detect fluorescently labeled cell concentrations of 1.9 × 10(4) CFU/mL, indicating it is suitable for detecting typical concentrations of degrader organisms reported in bioremediation trials. The effect of fluorophore photobleaching was characterized for different fluorescent proteins and demonstrated a linear relationship to cell concentration, meaning the effect can be accounted for within methods of fluorescence collection and analysis. Proof of concept is provided for all aspects of this research, which represents an important step toward the goal of achieving a complete, nondestructive, in situ monitoring system to characterize all aspects of microbial activity and gene expression.

Marital loss, mental health and the role of perceived social support: findings from six waves of an Australian population based panel study.

OBJECTIVES: To investigate the impact of transitions out of marriage (separation, widowhood) on the self reported mental health of men and women, and examine whether perceptions of social support play an intervening role. METHODS: The analysis used six waves (2001-06) of an Australian population based panel study, with an analytical sample of 3017 men and 3225 women. Mental health was measured using the MHI-5 scale scored 0-100 (α=0.97), with a higher score indicating better mental health. Perceptions of social support were measured using a 10-item scale ranging from 10 to 70 (α=0.79), with a higher score indicating higher perceived social support. A linear mixed model for longitudinal data was used, with lags for marital status, mental health and social support. RESULTS: After adjustment for social characteristics there was a decline in mental health for men who separated (-5.79 points) or widowed (-7.63 points), compared to men who remained married. Similar declines in mental health were found for women who separated (-6.65 points) or became widowed (-9.28 points). The inclusion of perceived social support in the models suggested a small mediation effect of social support for mental health with marital loss. Interactions between perceived social support and marital transitions showed a strong moderating effect for men who became widowed. No significant interactions were found for women. CONCLUSION: Marital loss significantly decreased mental health. Increasing, or maintaining, high levels of social support has the potential to improve widowed men's mental health immediately after the death of their spouse.

Short-term functional health and well-being after marital separation: does initiator status make a difference?

The authors investigated the health consequences of marital separation and whether the partners who initiated the separation had better health than those who did not. The data came from the Households, Income and Labour Dynamics in Australia (HILDA) panel study (2001-2007), comprising an analytic sample of 1,786 men and 2,068 women who were in their first marriages in 2001. For participants who separated, the authors distinguished between self-initiated, partner-initiated, and jointly initiated separations. Using linear random-intercept models, they examined scores on the 8 physical and mental health dimensions of Short Form 36, with scale scores ranging from 0 to 100. The results indicated that in general, men who separated had a decline in health, although this was more pronounced for mental dimensions than for physical dimensions. Among separated men, those whose partner initiated the separation had poorer mental health than those for whom the separation was self-initiated or jointly initiated (-4.61). Women's physical health improved with separation, but their mental health declined. For separated women, those whose partner initiated the separation had lower scores on the general health (-5.39), role-emotional (-11.08), and mental health (-7.18) scales than women who self-initiated separation. The health consequences of separation were less severe for self- or jointly initiated separations, suggesting that not all marital dissolutions are equally bad for health.