A longitudinal study of the mental health impacts of job loss: the role of socioeconomic, sociodemographic, and social capital factors.

OBJECTIVES: To examine the role of socioeconomic, sociodemographic, and social capital factors in buffering or exacerbating the mental health impacts of job loss. METHODS: A 2-year longitudinal cohort study of 300 workers experiencing job loss from a motoring manufacturer in Adelaide, South Australia. Data were collected on mental health (12-item version of the General Health Questionnaire) and socioeconomic, sociodemographic, and social capital factors. Analysis used linear mixed-effects regression. RESULTS: Workers had poorer mental health than the general population. Female gender, less years at the plant, and not being partnered were associated with poorer mental health. The effects of financial status depended on current employment and levels of social support. Trust and social contact were associated with better mental health. CONCLUSION: A number of socioeconomic, sociodemographic, and social capital factors influence mental health in workers experiencing job loss, offering clues on how to support workers.

A qualitative study of the interactions among the psychosocial work environment and family, community and services for workers with low mental health.

BACKGROUND: The psychosocial work environment can benefit and harm mental health. Poor psychosocial work environments and high level work-family conflict are both associated with poor mental health, yet little is known about how people with poor mental health manage the interactions among multiple life domains. This study explores the interfaces among paid work, family, community and support services and their combined effects on mental health. METHODS: We conducted 21 in-depth semi-structured interviews with people identified as having poor mental health to examine their experiences of paid employment and mental health and wellbeing in the context of their daily lives. RESULTS: The employment-related psychosocial work environment, particularly workplace relationships, employment security and degree of control over hours, strongly affected participants' mental health. The interfaces among the life domains of family, community and access to support services suggest that effects on mental health differ according to: time spent in each domain, the social, psychological and physical spaces where domain activities take place, life stage and the power available to participants in their multiple domains. This paper is based on a framework analysis of all the interviews, and vignettes of four cases. Cases were selected to represent different types of relationships among the domains and how interactions among them either mitigated and/or exacerbated mental health effects of psychosocial work environments. CONCLUSIONS: Examining domain interactions provides greater explanatory capacity for understanding how people with low mental health manage their lives than restricting the research to the separate impacts of the psychosocial work environment or work-family conflict. The extent to which people can change the conditions under which they engage in paid work and participate in family and social life is significantly affected by the extent to which their employment position affords them latitude. Policies that provide psychosocial protections to workers that enable them to make changes or complaints without detrimental repercussions (such as vilification or job loss) and increase access to welfare benefits and support services could improve mental health among people with paid work. These policies would have particularly important effects for those in lower socioeconomic status positions.

Deliberately casual? Workers' agency, health, and nonstandard employment relations in Australia.

OBJECTIVE: We explored Australian workers' experiences of nonstandard employment, how it related to health and well-being, and the role that Bourdieu's forms of capital (cultural, economic, and social resources) played in underpinning workers' agency. METHODS: Qualitative data from semistructured interviews with 32 causal workers were analyzed on the basis of framework analysis. RESULTS: Most participants were "deliberate casuals" who had chosen casual over permanent employment, with half of that group naming improved health and well-being as motivation. Those with greater access to capital felt more able to exercise choice, whereas those with fewer capital resources felt constrained to be casual. Gendered structures and labor market dynamics were also significant in shaping agency. CONCLUSIONS: Access to capital and a buoyant labor market underpinned workers' agency in Australia, enabling some to gain health and well-being benefits from nonstandard employment.

Precarious employment, psychosocial working conditions, and health: Cross-sectional associations in a population-based sample of working Australians.

BACKGROUND: Precarious employment has been associated with poor health, but the potential mechanisms are unclear. We examined the relationships between precarious employment and health, and investigated psychosocial working conditions as potential mediators. METHODS: A cross-sectional population-based survey was conducted in South Australia in 2009 (N = 1,016 employed). SF-12 measures of mental and physical health were modeled using logistic regression in relation to employment arrangement, controlling for socio-demographics, years in job and psychosocial working conditions. RESULTS: There was no association between casual full-time or part-time employment and poor mental health in multivariate analyses. Conversely, there was a significant association between casual full-time employment and poor physical health (compared to permanent full-time workers, OR = 3.14, 95% CI 1.26-7.85). The association with physical health was unaffected by adjustment for psychosocial working conditions. CONCLUSIONS: Casual full-time employment was strongly associated with poor physical health but not with poor mental health. This association was not mediated by the psychosocial working conditions measured in this study, but may be related to other (unmeasured) working conditions.

Workplace bullying a risk for permanent employees.

OBJECTIVE: We tested the hypothesis that the risk of experiencing workplace bullying was greater for those employed on casual contracts compared to permanent or ongoing employees. METHODS: A cross-sectional population-based telephone survey was conducted in South Australia in 2009. Employment arrangements were classified by self-report into four categories: permanent, casual, fixed-term and self-employed. Self-report of workplace bullying was modelled using multiple logistic regression in relation to employment arrangement, controlling for sex, age, working hours, years in job, occupational skill level, marital status and a proxy for socioeconomic status. RESULTS: Workplace bullying was reported by 174 respondents (15.2%). Risk of workplace bullying was higher for being in a professional occupation, having a university education and being separated, divorced or widowed, but did not vary significantly by sex, age or job tenure. In adjusted multivariate logistic regression models, casual workers were significantly less likely than workers on permanent or fixed-term contracts to report bullying. Those separated, divorced or widowed had higher odds of reporting bullying than married, de facto or never-married workers. CONCLUSIONS: Contrary to expectation, workplace bullying was more often reported by permanent than casual employees. It may represent an exposure pathway not previously linked with the more idealised permanent employment arrangement. IMPLICATIONS: A finer understanding of psycho-social hazards across all employment arrangements is needed, with equal attention to the hazards associated with permanent as well as casual employment.

Responding to racism: insights on how racism can damage health from an urban study of Australian Aboriginal people.

This paper examines responses to racism and the pathways through which racism can affect health and wellbeing for Aboriginal people living in an urban environment. Face-to-face interviews were conducted in 2006/07 with 153 Aboriginal people living in Adelaide, Australia. Participants were asked about their experience of, and responses to, racism, and the impact of these experiences on their health. Racism was regularly experienced by 93% of participants. Almost two thirds of people felt that racism affected their health. Using a thematic analysis with a particular focus on how agency and structure interacted, a number of key reactions and responses to racism were identified. These included: emotional and physiological reactions; and responses such as gaining support from social networks; confronting the person/situation; ignoring it; avoiding situations where they might experience racism; 'minimising' the significance or severity of racism or questioning whether incidents were racist; and consuming alcohol, tobacco and other drugs. A further theme was a conscious decision to not 'allow' racism to affect health. Our study found that most people used more than one of these coping strategies, and that strategies were selected with an awareness of positive and negative health impacts. While individuals demonstrated substantial agency in their responses, there were clear structural constraints on how they reacted and responded. We found that not only was racism potentially detrimental to health, but so too were some responses. However, while some strategies appeared 'healthier' than others, most strategies entailed costs and benefits, and these depended on the meanings of responses for individuals. This paper concludes that initiatives to promote health-protective responses to racism need to consider structural constraints and the overarching goal of reducing systemic racism.

From causes to solutions--insights from lay knowledge about health inequalities.

BACKGROUND: This paper reports on a qualitative study of lay knowledge about health inequalities and solutions to address them. Social determinants of health are responsible for a large proportion of health inequalities (unequal levels of health status) and inequities (unfair access to health services and resources) within and between countries. Despite an expanding evidence base supporting action on social determinants, understanding of the impact of these determinants is not widespread and political will appears to be lacking. A small but growing body of research has explored how ordinary people theorise health inequalities and the implications for taking action. The findings are variable, however, in terms of an emphasis on structure versus individual agency and the relationship between being 'at risk' and acceptance of social/structural explanations. METHODS: This paper draws on findings from a qualitative study conducted in Adelaide, South Australia, to examine these questions. The study was an integral part of mixed-methods research on the links between urban location, social capital and health. It comprised 80 in-depth interviews with residents in four locations with contrasting socio-economic status. The respondents were asked about the cause of inequalities and actions that could be taken by governments to address them. RESULTS: Although generally willing to discuss health inequalities, many study participants tended to explain the latter in terms of individual behaviours and attitudes rather than social/structural conditions. Moreover, those who identified social/structural causes tended to emphasise individualized factors when describing typical pathways to health outcomes. This pattern appeared largely independent of participants' own experience of advantage or disadvantage, and was reinforced in discussion of strategies to address health inequalities. CONCLUSIONS: Despite the explicit emphasis on social/structural issues expressed in the study focus and framing of the research questions, participants did not display a high level of knowledge about the nature and causes of place-based health inequalities. By extending the scope of lay theorizing to include a focus on solutions, this study offers additional insights for public health. Specifically it suggests that a popular constituency for action on the social determinants of health is unlikely to eventuate from the current popular understandings of possible policy levers.

Do perceived neighbourhood cohesion and safety contribute to neighbourhood differences in health?

This paper reports on a survey (N=3344) and in-depth interviews (N=80) from four socio-economically contrasting postcode areas in Adelaide. Logistic regression was used to examine locational differences in self-rated health, controlling for demographic, socio-economic factors, health behaviours, individual social capital (social networks, support, reciprocity, trust) and perceived neighbourhood cohesion and safety. Statistically significant locational differences in health emerged. Perceived neighbourhood cohesion and safety accounted for this difference. Interviews explored perceptions of cohesion and safety and found that they were intricately related and varied between the areas. The implications of the findings for understanding locational differences in health are discussed.

Social capital and health in rural and urban communities in South Australia.

OBJECTIVE: This paper seeks to compare the relationships between social capital and health for rural and urban residents of South Australia. METHODS: Using data from a South Australian telephone survey of 2,013 respondents (1,402 urban and 611 rural), separate path analyses for the rural and urban samples were used to compare the relationships between six social capital measures, six demographic variables, and mental and physical health (measured by the SF-12). RESULTS: Higher levels of networks, civic participation and cohesion were reported in rural areas. Education and income were consistently linked with social capital variables for both rural and urban participants, with those on higher incomes and with higher educational achievement having higher levels of social capital. However, there were also differences between the rural and urban groups in some of the other predictors of social capital variables. Mental health was better among rural participants, but there was no significant difference for physical health. Social capital was associated with good mental health for both urban and rural participants, but with physical health only for urban participants. Higher levels of social capital were significantly associated with better mental health for both urban and rural participants, but with better physical health only for urban participants. CONCLUSIONS AND IMPLICATIONS: The study found that social capital and its relationship to health differed for participants in rural and urban areas, and that there were also differences between the areas in associations with socioeconomic variables. Policies aiming to strengthen social capital in order to promote health need to be designed for specific settings and particular communities within these.

I don't think general practice should be the front line: Experiences of general practitioners working with refugees in South Australia.

INTRODUCTION: Many refugees arrive in Australia with complex health needs. In South Australia (SA), providing initial health care to refugees is the responsibility of General Practitioners (GPs) in private practice. Their capacity to perform this work effectively for current newly arrived refugees is uncertain. The aim of this study was to document the challenges faced by GPs in private practice in SA when providing initial care to refugees and to discuss the implications of this for policy relating to optimising health care services for refugees. METHODS: Semi-structured interviews with twelve GPs in private practice and three Medical Directors of Divisions of General Practice. Using a template analysis approach the interviews were coded and analysed thematically. RESULTS: Multiple challenges providing care to refugees were found including those related to: (1) refugee health issues; (2) the GP-refugee interaction; and (3) the structure of general practice. The Divisions also reported challenges assisting GPs to provide effective care related to a lack of funding and awareness of which GPs required support. Although respondents suggested a number of ways that GPs could be assisted to provide better initial care to refugees, strong support was voiced for the initial care of refugees to be provided via a specialist refugee health service. CONCLUSION: GPs in this study were under-resourced, at both an individual GP level as well as a structural level, to provide effective initial care for refugees. In SA, there are likely to be a number of challenges attempting to increase the capacity of GPs in private practice to provide initial care. An alternative model is for refugees with multiple and complex health care needs as well as those with significant resettlement challenges to receive initial health care via the existing specialist refugee health service in Adelaide.

Health implications of access to social capital: findings from an Australian study.

This paper considers the health implications of access to social capital (SC) using data from a survey of households in two suburbs in Adelaide, Australia. SC was conceptualised as comprising 'infrastructure'--the networks and values that facilitate access to resources; and 'resources'--the resources available through this infrastructure. Questionnaires were delivered to all households in the area, asking the adult with the next birthday to complete it. In all, 530 (50%) were returned. A partial least-squares path analysis was undertaken using demographic, SC and health latent variables, and a measure of perceived relative advantage. Three infrastructure (values, formal networks and informal networks) and four resource (help, acceptance by neighbours, civic activities and feelings of control) variables were considered. Mental and physical health were measured using the SF-12. The values variable was associated with all the resource variables, the informal networks variable was related to help, and the formal networks variable was associated with civic actions. There were significant sociodemographic differences in a number of the infrastructure and resource variables, as well as mental and physical health. Those who were better off materially also had greater access to elements of SC, and reported better health. Values, informal networks, help, and control were all directly or indirectly positively associated with better mental health. No SC variables were associated with physical health. Perceived relative advantage was positively associated with a number of SC variables and also mental and physical health. The implications for health promotion are discussed.

Neighbourhood life and social capital: the implications for health.

Social capital has been linked to health outcomes, though there are some inconsistencies in the research and the link is dependent on the measures of social capital and health used. In this paper, we argue that social capital is multifaceted and its relationship with health is complex. We explore the relationship between a number of elements of neighbourhood life and neighbourhood-based social capital, and health, using both qualitative and quantitative methods. The paper reports on a study of the Western suburbs of Adelaide and the analysis of 2400 questionnaires and 40 in-depth interviews. A partial least-square path analysis was undertaken with the questionnaire data. It considered the impact of perceptions of the physical environment, neighbourhood connections, neighbourhood trust, reciprocity, perceived safety and local civic action, and a number of demographic variables, on physical and mental health as measured by the SF-12. Of the neighbourhood-related variables, only perceived neighbourhood safety was related to physical health, with neighbourhood safety and neighbourhood connections related to mental health. Of the demographic variables, higher-income level and educational achievement were related to better physical and mental health. In addition, physical health was lower and mental health higher within older age groups. The inter-relationships between the neighbourhood variables and demographic differences in experience of neighbourhood were also examined. The thematic analysis of the interviews linked a number of social aspects of neighbourhood, the physical neighbourhood environment, perceptions of safety, civic activities and availability of local services, to health outcomes. The paper concludes that there is a need for more complex measures of social capital and that socio-economic factors are of relatively greater importance in determining health.