TABLE 3—
Study Outcomes in Literature Review on Association Between Returning to Work and Health Among Working-Aged Adults
| Study | Sample Size at Each Data Collection Point, No. (% completed) | Follow-up (Data Collection Points, No.). | Health Outcomes (Confounders) | Main Findings |
| Beiser et al.79,a | Baseline: 1348Follow-up: 1169 (87) | 2 y (2) | Depressive affect (Baseline depression score, education, gender, age, baseline and follow-up marital status) | With all other factors controlled, the consistently employed had significantly lower depression scores at follow-up than the consistently unemployed or people who lost their jobs between baseline and follow-up, but not lower than the previously unemployed who found jobs by follow-up |
| Starting a job between baseline and follow-up was accompanied by lowered depression scores | ||||
| Refugees employed at baseline who went on to lose their job had higher initial depression levels than the initially employed who kept on working | ||||
| Bond et al.80,a | Baseline: 149Follow-up 1: 149 (100)Final follow-up: 149 (100) | 1.5 y (4) | Psychiatric symptoms [BPRS score total] (Group assignment [IPS versus control], months of paid employment in past 5 y, Global Assessment Scale days in hospital in past year) | Clients with severe mental illness who worked in competitive employment for an extended period showed a greater rate of improvement in several nonvocational outcomes (including overall BPRS); statistical differences partially attributable to deterioration in minimal work and nonworking groups |
| Competitive group unchanged on the BPRS total from baseline to 18 mo; nonworking group deteriorated substantially | ||||
| Breslin and Mustard20,b | Baseline: 6096Final follow-up: 6096 (100) | 2 y (2) | Distress, depression (Gender, marital status, education, unusual life events, chronic medical condition) | Adults aged 31–55 y who became unemployed more likely to report elevated distress at follow-up 1 than those who remained employed; review analyses of cases of clinical depression showed similar but somewhat weaker association (causation for job loss, not return-to-work effect) |
| High distress increased risk of not finding work; review analysis found that unemployment predicted distress and distress predicted employment status, supporting selection hypothesis | ||||
| Review analyses did not show increased distress at follow-up among those unemployed at both time points, suggesting adaptation to unemployment | ||||
| Bromberger and Matthews81,a | Baseline: 541Final follow-up: 524 (97) | 3 y (2) | Depression [BDI] (Education, marital status) | Depressive symptoms decreased among newly employed and increased for others |
| New employment appeared to have acute positive effect on mood | ||||
| Caplan et al.82,a | Baseline: 928Follow-up 1: 693 (75)Final follow-up: 628 (68) | 4 mo (3) | Depression, anxiety, quality of life (Baseline scores for dependent variables) | People who found reemployment scored significantly lower on anxiety, depression, and anger and higher on self-esteem and quality of life than persons who remained unemployed |
| Claussen83,84,ac | Baseline: 310Follow-up 1: 291 (94)Final follow-up: 210 (68) | 2 y835 y84 (3) | Somatic symptoms, anxiety, depression, psychiatric syndrome personality disorder, hormones [cortisol, testosterone, prolactine], immunoglobins (Education, years in paid work, duration of longest-lasting job, gender, socioeconomic status, social network, health measures at baseline) | At 5-y follow-up, considerable recovery after reemployment, supporting causation hypothesis84Results differed from 2-y follow-up, when selection was remarkable and recovery after reemployment was fairly small83Psychiatric syndrome diagnosis at baseline (1988) reduced odds of having job in 1993; 43% of changes occurred in participants without a diagnosis |
| Claussen85,ad | Baseline: 310Follow-up 1: 291 (93.9)Final follow-up: 228 (73.5) | 5 y (3) | Alcohol dependency (Gender, age, education, socioeconomic status, social network, employment, commitment, AUDIT case for alcohol dependency at baseline) | Obtaining job significantly reduced chances of scoring positive on AUDIT questionnaire from 1988 to 1993 to 34% of odds for still-unemployed persons; calculating continuous AUDIT scores in linear regression with continuous covariates gave same result (P = .02); recovery likely same as deterioration after job loss |
| Selection mechanism probably not major cause of high prevalence of alcohol problems in unemployed populations | ||||
| DiClementi et al.86,b | Unemployed–employed:baseline: 135Final follow-up: 135 (100)Unemployed–unemployed:Baseline: 135Final follow-up: 135 (100) | 5 y (2) | Mental illness [other than substance abuse, psychiatric diagnoses, injection drug use] | Return-to-work group had significantly more psychiatric diagnoses other than substance abuse than matched control group; control group had significantly more diagnoses related to injection and other drug use, possibly because accessing mental health services was entry point into the return-to-work program, and substance abuse may be associated with avoidance or inability to access mental health treatmente |
| Ginexi et al.87,a | Baseline: 254Follow-up 1: 228 (90)Final follow-up: 214 (84) | 11 mo (3) | Depression (Gender, minority status, age, SES) | Reemployed job seekers showed significantly steeper linear reduction in symptoms (dropping an average of 4.55 points faster over the year). |
| Reemployment within 6 mo predicted declines in average and individual levels of depressive symptoms, implying that early reemployment was related to resolution of depressive symptoms | ||||
| Pattern did not hold for reemployment obtained after 6 mo; job seekers who still unemployed at follow-up 1 had higher, stable level of depressive symptoms throughout study | ||||
| Depressive symptoms failed to predict time to any reemployment or time to permanent full-time reemployment | ||||
| Martikainen and Valkonen8,a | Baseline: 2.5 millionFinal follow-up: 2.5 million (100) | 5 y (3) | Mortality (Age, education, occupational class, marital status) | Jobless persons who were reemployed had higher mortality than those who were continuously employed, lower than those who remained unemployed, after controls for confounders |
| Excess mortality of unemployed persons during times of low national unemployment greater than during recession | ||||
| Association between unemployment and mortality weakened as general unemployment rate increased | ||||
| Mueser et al.88,a | Baseline: 143Final follow-up: 133 (93) | 1.5 y (4) | Psychiatric symptoms (Gender, diagnosis, vocational group) | Persons working at follow-up tended to have fewer symptoms (particularly thought disorder and affect on the BPRS), higher Global Assessment scores, better self-esteem, and more satisfaction with finances and vocational services than did unemployed persons. Employment was associated with better functioning in a range of nonvocational domains, even after control for baseline functioning, suggesting benefit of rehabilitation program |
| Results may reflect combined effects of less symptomatic patients finding jobs more easily and benefits of work for functioning, although neither hypothesis alone was directly supported by data | ||||
| Payne and Jones89,a | Baseline: 399Follow-up 1: 286 (71.7)Final follow-up: 144 (36.1)f | 2 y (3) | General psychological distress, anxiety, depression (Not reported) | Perceived psychological symptoms improved, regardless of occupational status, after reemployment |
| Schaufeli and VanYperen90,b | Baseline: 467Final follow-up: 317 (64.1) | 2 y (4) | Psychological distress (Gender) | General tendency toward better psychological health observed in both reemployed and continuously long-term unemployed groups; long-term unemployed reached plateau health, then adapted |
| Less distressed long-term unemployed technical college graduates were more likely than more distressed to become reemployed, supporting selection hypothesis | ||||
| Soumerai and Avorn91,a | Baseline: 54Final follow-up: 47 (87%)g | 6 mo (2) | Perceived health status (Not reported) | Strongest effect of employment program at completion was on perceived health: 8% of intervention participants reported health as fair, 36% as excellent; 45% of control participants had fair and 14% had excellent health |
| Results similar for perceived changes in health over the previous 6 mo | ||||
| Although most respondents in both groups perceived no change health, improvements in health were far more common in intervention participants, and health declines more common in control participants; differences were statistically highly significant | ||||
| Studnicka et al.92,a | Baseline: 172Final follow-up: 172 (100)Unemployed–employed: 106Unemployed–unemployed: 66 | 1 y (2) | Psychological health, physical health in past year (Age, gender, previous level of employment, physical health, previous unemployment) | Persons unemployed 12 mo were 8 times as likely as the reemployed to report poor psychological health (OR = 8.5; 95% CI = 4.2, 17.0)Self-reported physical ill health likely attributable largely to former work (56% of all disorders were related by respondents to former work history) and to be associated with current employment status (OR = 5.6; 95% CI = 2.7, 11.5) |
| Unemployed overused health services (OR = 2.2;95% CI = 1.2, 4.1); this differential was greater for older and sicker persons | ||||
| Thomas et al.93,a | Baseline: 5092Final follow-up: 5092 (100) | 8 y (8) | Psychological distress [GHQ score ³ ≥ 3] (Age, gender, long-term sickness, previous GHQ case) | For both men and women, transitions from paid employment to either unemployment or long term illness were associated with poor mental health |
| Transitions from unemployment into paid employment were associated with good mental health | ||||
| Effects of transitions on mental health strongest in first 6 mo | ||||
| People with considerable psychological distress during unemployment were less likely to become employed, supporting selection hypothesis | ||||
| Vuori and Vesalainen94,a | Baseline: 559Final follow-up: 401 (71.7) | 1 y (2) | Psychological distress [GHQ] (Baseline job seeking activity, baseline psychological distress, baseline financial situation, follow-up 1 financial situation, type of intervention) | Participants who were unemployed at both measurement times reported no change in amount of distress symptoms over timeReemployed and unemployed persons at follow-up 1 did not differ in baseline distress symptoms (t(374) = 0.01; NS), failing to support selection hypothesis |
| At follow-up 1, reemployed persons reported significantly fewer symptoms than did unemployed (t(375) = 3.83; P < .001) | ||||
| Warr and Jackson95,a | Baseline: 954Follow-up 1: 629 (66) | 9 mo (2) | Psychological ill health [GHQ], general Health change, physical health change, psychological health change (None) | Gaining (and maintaining) a job significantly improved psychological health and reported health and reduced financial strain |
Note. AUDIT = Alcohol Use Disorders Identification Test; BDI = Beck Depression Inventory; BPRS = Brief Psychiatric Ratings Scale; CI = confidence interval GHQ = General Health Questionnaire; NS = not signficant; OR = odds ratio; SES = socioeconomic status.
a
Study showed a beneficial health effect of returning to work.
b
Study showed no health effect of returning to work.
c
Articles reported data from the same participants, the 1994 article83 at 2-year follow-up and the 1999 article84 at 5-year follow-up.
d
Same participants as Clausen's other articles,83,84 but reported separately because outcome and sample attrition rates were different.
e
Return-to-work group received diagnoses from mental health team; matched control participants received substance use disorder diagnoses during medical examinations, emergency room visits, and incarceration, not from study mental health team.
f
Only participants who were unemployed at baseline and follow-up 1 were reinterviewed at final follow-up.
g
For experimental group, attrition = 100%; for control group, attrition = 76%.