Work-related suicide: Evolving understandings of etiology & intervention.

Previously published analyses of suicide case investigations suggest that work or working conditions contribute to 10%-13% of suicide deaths. Yet, the way in which work may increase suicide risk is an underdeveloped area of epidemiologic research. In this Commentary, we propose a definition of work-related suicide from an occupational health and safety perspective, and review the case investigation-based and epidemiologic evidence on work-related causes of suicide. We identified six broad categories of potential work-related causes of suicide, which are: (1) workplace chemical, physical, and psychosocial exposures; (2) exposure to trauma on the job; (3) access to means of suicide through work; (4) exposure to high-stigma work environments; (5) exposure to normative environments promoting extreme orientation to work; and (6) adverse experiences arising from work-related injury or illness. We summarise current evidence in a schema of potential work-related causes that can also be applied in workplace risk assessment and suicide case investigations. There are numerous implications of these findings for policy and practice. Various principle- and evidence-based workplace intervention strategies for suicide prevention exist, some of which have been shown to improve suicide-prevention literacy, reduce stigma, enhance helping behaviours, and in some instances maybe even reduce suicide rates. Prevailing practice in workplace suicide prevention, however, overly emphasises individual- and illness-directed interventions, with little attention directed to addressing the working conditions that may increase suicide risk. We conclude that a stronger emphasis on improving working conditions will be required for workplace suicide prevention to reach its full preventive potential.

Workplace Injury Compensation and Mental Health and Self-Harm Outcomes: A Systematic Review.

Workers' compensation systems aim to financially support injured workers. However, seeking compensation often leads to poorer physical and mental health outcomes. This review examines previous studies to investigate the relationship between workers' compensation and mental health and self-harm outcomes. A three-tiered search strategy across five databases identified studies that examined workers' compensation claims as an exposure or risk factor, with outcomes related to mental health, self-harm and suicidality. Nine full-text studies were included; however, heterogeneity limited generalizability. Most studies supported an association between pursuing compensation and poorer mental health and self-harm outcomes. Some studies attributed this to specific aspects of the system such as justice perception and navigation of the claims system. Findings suggest an association between workers' compensation and mental health or self-harm outcomes. Inconclusive findings highlight the need for further research. Understanding the psychiatric impacts of pursuing compensation is crucial to help formulate a more accessible compensation system.

Trajectories of job insecurity and the probability of poorer mental health among prime working-age Australian women and men.

Precarious and insecure employment arrangements are important social determinants of health. Prior evidence has consistently found perceived job insecurity to be associated with poorer mental health. Nonetheless, several key under-researched areas remain in the existing evidence base. This study addresses some of these gaps by examining trajectories of job (in)security and assessing the effect of various persistent job security trajectories on subsequent mental health of both men and women. Utilising 15 waves of data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey, we employed group-based trajectory modelling (GBTM) to identify trajectories of job (in)security through men and women's prime working years (from baseline age of 28-38yrs to 41-51yrs) across 14 years (waves 5-18), before subsequently examining the associations between these estimated trajectories and mental health at wave 19 (aged 42-52yrs). We identified four distinct trajectories of job (in)security for both men and women: persistently secure, becoming more secure, becoming less secure, and persistently insecure. Examining the association between these trajectories and mental health, we found that chronic exposure to any amount of persistent job insecurity (improving, worsening or persistently insecure) is detrimental to the mental health of both men and women. Furthermore, a somewhat incremental or dose dependant effect was found, with persistent job insecurity associated with the largest declines in mental health scores. Given mental health disorders are a substantial cause of disability globally, our study provides evidence that developing policy and practice interventions to reduce job insecurity (as an increasingly recognised and highly modifiable social determinant of mental health) has considerable potential to enact positive population health improvements.

Impact of informal caregiving on depressive symptoms among a national cohort of men.

BACKGROUND: There is evidence that unpaid caregiving can have negative effects on the mental health of female caregivers; however, evidence of impacts on male caregivers is limited. This study addressed this gap by examining associations between becoming a caregiver and depressive symptoms among men. METHODS: We used data from waves 1-2 (2013, 2016) of the Longitudinal Study of Australian Male Health (Ten to Men). Effects of incident caregiving on depressive symptoms were estimated using augmented inverse probability treatment weighting, with adjustment for potential confounders. Incident caregiving was assessed as a binary variable (became a caregiver vs not), and depressive symptoms were measured using the Patient Health Questionnaire (moderate to severe depressive symptoms; yes, no). Main analysis was prospective, drawing on wave 1 (caregiving) and wave 2 (depressive symptoms), and sensitivity analyses modelled cross-sectional associations. RESULTS: In the main analysis, incident caregiving in wave 1 was associated with depressive symptoms in the subsequent wave, with an average treatment effect of 0.11 (95% CI 0.06, 0.17) and equating to a risk ratio of 2.03 (95% CI 1.55, 2.51). Associations were robust to several sensitivity analyses, with cross-sectional associations supporting the main prospective analyses. CONCLUSION: These results provide evidence of the association between caregiving and depressive symptoms among male caregivers. This has important implications for policy and support programmes. As we seek to shift caregiving responsibilities toward a more gender-equal distribution of care, policy must recognise that, like female caregivers, male caregivers also experience mental health impacts related to their caregiving role.

Unpaid caregiving and mental health during the COVID-19 pandemic-A systematic review of the quantitative literature.

The COVID-19 pandemic imposed additional and specific challenges on the lives and wellbeing of informal unpaid carers. Addressing an important gap in the existing literature, this systematic review (prospectively registered with PROSPERO CRD42022376012) synthesises and evaluates the quantitative evidence examining the association between unpaid caregiving and mental health (compared to non-caring), during the pandemic. Five databases were searched (Medline, PsycInfo, EMBASE, Scopus, Web of Science) from Jan 1, 2020, to March 1, 2023. Population-based, peer-reviewed quantitative studies using any observational design were included, with screening, data extraction and quality assessment (amended NOS) independently conducted by two reviewers. Of the 3,073 records screened, 20 eligible studies (113,151 participants) were included. Overall quality of evidence was moderate. Narrative synthesis was complemented by Effect-direction and Albatross plots (given significant between-study heterogeneity precluded meta-analysis). Results indicate that the mental health of informal carers, already poorer pre-COVID compared to non-caregivers, was disproportionally impacted as a result of the pandemic and its associated public health containment measures. This review highlights the vulnerability of this group and should motivate political will and commensurate policies to ensure unpaid caregivers are better supported now, in the medium term, and crucially if, and when, another global public health emergency emerges.

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.

Impact of informal care on the mental health of caregivers during the COVID-19 pandemic.

BACKGROUND: Informal care can affect the mental health of caregivers. The COVID-19 pandemic precipitated many people into informal care. Little is known about the longitudinal effect of informal care throughout the pandemic. We investigate changes in mental health in relation to changes in informal care between July 2020 and September 2021. METHODS: Using data from Understanding Society, we applied fixed-effects modelling to assess mental health variations associated with changes in caregiving among 13 557 participants (50 430 observations). Hours of weekly care were categorized as 0, 1-19, ≥20. Mental health was measured using the General Health Questionnaire (GHQ-12) as a continuous score and a binary indicator. Main analyses were stratified by gender. RESULTS: Compared to when delivering 0 hours care/week, the GHQ-12 scores of women providing care for 1-19 hours/week were 0.46 points higher (95%CI: -0.11, 1.09), while their mental health scores were 0.99 higher (95%: 0.08, 1.90) when caring for ≥20 hours/week. Changes on the binary GHQ-12 measure were only evident for women when providing ≥20 hours of weekly care. These changes were not substantial among men. CONCLUSION: Informal care adversely impacted the mental health of women carers during the COVID-19 pandemic. Support programmes for informal carers should focus on alleviating caregiving loads in women.

Suicide in the Australian Mining Industry: Assessment of Rates among Male Workers Using 19 Years of Coronial Data.

Background: International evidence shows that mining workers are at greater risk of suicide than other workers; however, it is not known whether this applies to the Australian mining sector. Methods: Using data from the National Coronial Information System, rates of suicide among male mining workers were compared to those of three comparators: construction workers, mining and construction workers combined, and all other workers. Age-standardized suicide rates were calculated for 2001-2019 and across three intervals '2001-2006', '2007-2011', and '2012-2019'. Incidence rate ratios for suicide were calculated to compare incidence rates for mining workers, to those of the three comparative groups. Results: The suicide rate for male mining workers in Australia was estimated to be between 11 and 25 per 100,000 (likely closer to 25 per 100,000) over the period of 2001-2019. There was also evidence that the suicide rate among mining workers is increasing, and the suicide rate among mining workers for the period 2012-2019 was significantly higher than the other worker group. Conclusions: Based on available data, we tentatively deduce that suicide mortality among male mining workers is of concern. More information is needed on both industry and occupation of suicide decedents in order to better assess whether, and the extent to which, mining workers (and other industries and occupations) are at increased risk of suicide.

A systematic review comparing cardiovascular disease among informal carers and non-carers.

Exposure to chronic stress increases the risk of cardiovascular disease (CVD). Providing informal care is known to be a stressful activity, but it is not clear whether informal caregiving is associated with CVD risk. This systematic review aimed to summarise and assess the quantitative evidence examining the association between providing informal care to others and CVD incidence in comparison with non-carers. Eligible articles were detected by searching six electronic literature databases (CINAHL, Embase, Global Health, OVID Medline, Scopus, and Web of Science). Two reviewers appraised 1887 abstracts and 34 full-text articles against a set of a priori eligibility criteria to identify articles for inclusion. Quality assessment of included studies was performed using the ROBINS-E risk of bias tool. Nine studies were identified that quantitatively assessed the association between providing informal care and CVD incidence in comparison to not providing informal care. Overall, there was no difference in the incidence of CVD between carers and non-carers across these studies. However, within the subgroup of studies that examined care provision intensity (hours/week) higher CVD incidence was observed for the most intense caregiving group compared to non-carers. One study examined only CVD-related mortality outcomes, observing a reduction in mortality for carers compared to non-carers. More research is required to explore the relationship between informal care and CVD incidence.

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.

Longitudinal association between informal unpaid caregiving and mental health amongst working age adults in high-income OECD countries: A systematic review.

Background: Informal unpaid caregivers provide most of the world's care needs, experiencing numerous health and wealth penalties as a result. As the COVID-19 pandemic has highlighted, informal care is highly gendered. Longitudinal evidence is needed to assess the causal effect of caregiving on mental health. This review addresses a gap by summarising and appraising the longitudinal evidence examining the association between unpaid caregiving and mental health among working age adults in high-income Organisation for Economic Co-operation and Development (OECD) countries and examining gender differences. Methods: Six databases were searched (Medline, PsycInfo, EMBASE, Scopus, Web of Science, Econlit) from Jan 1, 2000 to April 1, 2022. Population-based, peer-reviewed quantitative studies using any observational design were included. Population of interest was working age adults. Exposure was any unpaid caregiving, and studies must have had a non-caregiving comparator for inclusion. Mental health outcomes (depression, anxiety, psychological distress/wellbeing) were measurable by validated self-report tools or professional diagnosis. Screening, data extraction and quality assessment (ROBINS-E) were conducted by two reviewers. The study was prospectively registered with PROSPERO (CRD42022312401). Findings: Of the 4536 records screened; 13 eligible studies (133,426 participants) were included. Overall quality of evidence was moderate. Significant between-study heterogeneity precluded meta-analysis, so albatross and effect-direction plots complement the narrative synthesis. Results indicate a negative association between informal unpaid care and mental health in adults of working age. Importantly, all included studies were longitudinal in design. Where studies were stratified by gender, caregiving had a consistently negative impact on the mental health of women. Few studies examined men but revealed a negative effect where an association was found. Interpretation: Our review highlights the need to mitigate the mental health risks of caregiving in working age adults. Whilst men need to be included in further scholarship, reducing the disproportionate caregiving load on women is a crucial requirement for policy development. Funding: Melbourne School of Population and Global Health, Targeted Research Support Grant.

Suicide trends among Australian construction workers during years 2001-2019.

In many Western countries, including Australia, construction workers have been identified as being at elevated risk of suicide compared to other workers. A variety of suicide prevention initiatives have been implemented and expanded to reduce suicide in this occupational group; however, the net effect of these is unknown. Using 19 years of national suicide data, this study examined the suicide mortality of Australian male construction workers relative to all other working males, and compared suicide rates over time between the two groups. Age-standardized suicide rates were calculated for construction workers and those employed in other occupations. 2001-2019 trends in age-standardized rates of suicide mortality were analyzed by joinpoint regression analysis. The annual average percentage change (AAPC) measure was calculated for both groups to quantify change over time within each group, complemented by a pair-wise AAPC comparison of changes in trends between the two groups over the 2001-2019 period. Australian male construction workers' overall age-standardized suicide rate was 26.6 per 100,000 persons compared to 13.2 per 100,000 for male workers employed in other occupations (pooled over the entire 2001-2019 period). Over time, the suicide mortality rate declined in both construction workers and those working in other occupations; however, the decline in suicide mortality was greater in construction workers (AAPC: -3.0; 95%CI -4.0, -2.0) compared to other workers (AAPC: 1.5; 95%CI -2.1, -1.0). The AAPC pair-wise comparison showed a significant difference between the rate of decline among construction versus other workers over the 19-year study period (AAPC: -1.4; 95%CI 0.4, 2.5), confirming a rapid decline among construction versus other male workers. This study provides evidence of a decline in suicide rates among Australian construction workers over the last two decades. This decline may be attributable to the combined effects of population-wide, male-specific, and sector-specific suicide prevention efforts over this same period, suggesting that the continuation or expansion of such efforts may lead to further declines.

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.

Submission to the Australian Senate Select Committee on Job Security on the Impact of Insecure or Precarious Employment on the Economy, Wages, Social Cohesion, and Workplace Rights and Conditions.

The Australian Senate announced a Select Committee in December of 2020 "to inquire into and report on the impact of insecure or precarious employment on the economy, wages, social cohesion and workplace rights and conditions." This New Solutions "Document" is a submission to the Australian Senate from independent Australian researchers focusing on the role of perceived job (in)security in this context, acknowledging that it only briefly addresses the role of unemployment, precarious employment, and other aspects of the broader phenomenon of insecure work. Submissions closed in March of 2021, and the Australian Senate is due to report its findings on 30 November 2021.

Changes in Job Control and Perceptions of General Health: A Longitudinal Analysis of Australian Workers, 2005 to 2017.

OBJECTIVE: This longitudinal study of Australian workers explores a possible causal relationship between job control and general health. METHODS: Our sample included 105,017 observations (18,574 persons) over 13 annual waves from working age participants with information on job control, general health, and other sociodemographic and health factors. Three complementary longitudinal modeling approaches were used to explore the causal relationship. RESULTS: There was a strong stepwise, mostly exposure to outcome, relationship between increasing job control and general health. Cumulative exposure to low job control resulted in increasingly worse general health. Taken together, these findings provide good evidence of a causal relationship between low job control and general health. CONCLUSION: This analysis with improved causal inference over previous research showed that change in job control is strongly associated with change in general health.

Gendered associations between household labour force participation and mental health using 17 waves of Australian cohort data.

PURPOSE: There is some evidence that employed women report more time pressure and work-life penalties than employed men and other women; however little is known about whether this exerts a mental health effect. This analysis examined associations between household labour force arrangements (household-employment configuration) and the mental health of men and women. METHODS: Seventeen waves of data from the Household Income and Labour Dynamics Survey (2001-2017) were used. Mental health was measured using the Mental Health Inventory (MHI-5). A six-category measure of household-employment configuration was derived: dual full-time employed, male-breadwinner, female-breadwinner, shared part-time employment (both part-time), male full-time/female part-time (modified male-breadwinner, MMBW), and female full-time/male part-time. Using fixed-effects regression methods, we examined the within-person effects of household-employment configuration on mental health after controlling for time-varying confounders. RESULTS: For men, being in the female-breadwinner configuration was associated with poorer mental health compared to being in the MMBW configuration (ß-1.98, 95% CI - 3.36, - 0.61). The mental health of women was poorer when in the male-breadwinner configuration, compared to when in the MMBW arrangement (ß-0.89, 95% CI - 1.56, - 0.22). CONCLUSION: These results suggest that the mental health of both men and women is poorer when not in the labour force, either as a man in the female-breadwinner arrangement, or as a woman in the male-breadwinner arrangement. These results are particularly noteworthy for women, because they pertain to a sizeable proportion of the population who are not in paid work, and highlight the need for policy reform to support women's labour force participation.

All-cause mortality and the time-varying effects of psychosocial work stressors: A retrospective cohort study using the HILDA survey.

The effects of poor-quality work (high job demands, low job control, job insecurity, and effort-reward imbalance) are harmful to health but it isn't clear whether exposure to these psychosocial work stressors over time translates into increased risk of mortality. OBJECTIVE: We investigated the effect of time-varying psychosocial work stressors on mortality using data from a longitudinal cohort of working Australians by examining association between job control, job demands, job insecurity, unfair pay overtime and all-cause mortality. We examined whether gender modified these relationships. METHODS: Over 20,000 participants from the Household Income and Labour Dynamics in Australia survey with self-reported repeated exposure measures were followed for 15 years. Survival analysis models with baseline hazard specified by the Weibull distribution were used to examine the association between psychosocial work stressors over time and mortality. RESULTS: Low job control (HR=1.39; 95% CI: 1.06-1.83) and job insecurity (1.36; 1.06-1.74) were associated with increased risk of mortality. High job demands (1.01; 0.75-1.34) and effort-reward unfairness (1.20; 0.90-1.59) were not associated with mortality. The effect of job insecurity was attenuated (1.20; 0.93-1.54) after controlling for sociodemographic and health risk factors. Male participants exposed to low job control and job insecurity had an 81% and 39% increase risk of mortality, respectively. CONCLUSIONS: Long-term exposure to low job control and low job security is associated with increased risk of all-cause mortality. Effects were largely restricted to males and persisted after adjustments for sociodemographic and health characteristics. The lack of effects observed for females may have been due to the small number of deaths in females. Awareness of implications of the adverse effects of psychosocial work stressors on health and mortality in workplaces, and interventions to improve job control and job security could contribute to better health and wellbeing, reducing the effect of psychosocial work stressors on mortality.

Psychosocial work stressors and risk of mortality in Australia: analysis of data from the Household, Income and Labour Dynamics in Australia survey.

OBJECTIVE: To examine the association between exposures to psychosocial work stressors and mortality in a nationally representative Australian working population sample. METHODS: 18 000 participants from the Household, Income and Labour Dynamics in Australia survey with self-reported job demands, job control, job security and fair pay psychosocial work stressors exposures at baseline were followed for up to 15 waves. Cox proportional hazards regression models were used to examine the association between psychosocial work stressors and mortality. Models were serially adjusted for each subgroup of demographic, socioeconomic, health and behavioural risk factors. RESULTS: Low job control was associated with a 39% increase in the risk of all-cause mortality (HR 1.39; 95% CI 1.04 to 1.85), controlling for demographic, socioeconomic, health and behavioural factors. A decreased risk of mortality was observed for workers with exposure to high job demands (HR 0.76; 95% CI 0.60 to 0.96, adjusted for gender and calendar), but the risk was attenuated after serially adjusting for socioeconomic status, health (HR=0.84; 95% CI 0.65 to 1.08) and behavioural (HR=0.79; 95% CI 0.60 to 1.04) factors. There did not appear to be an association between exposure to job insecurity (HR 1.03; 95% CI 0.79 to 1.33) and mortality, or unfair pay and mortality (HR 1.04; 95% CI 0.80 to 1.34). CONCLUSIONS: Low job control may be associated with an increased risk of all-cause mortality. Policy and practice interventions that reduce the adverse impact of low job control in stressful work environments could be considered to improve health and decrease risk of mortality.