The worries of working : Longitudinal studies on the impact of employment uncertainty and employment transitions on clinically defined mental health conditions

While mental health problems according psychotropic drug purchases and sick leave spells for psychiatric disorders have increased in Sweden the past 15 years, this is not reflected in trends of psychiatric diagnoses or suicide mortality. In parallel, labor markets have undergone structural changes pressuring employers to increase their flexibility to ensure permanence. In consequence, this may introduce greater uncertainty about employment continuity and involuntary job transitions for the employees. While evidence suggest that employment uncertainty increases the risk of self-reported mental health problems, the relation to clinically pertinent mental health conditions remains unclear. Therefore, this thesis aimed to investigate if employment uncertainty and involuntary labor market transitions, was associated with common and with severe clinically defined mental health conditions. All four studies relied on national health registers for ascertainment of clinically defined mental health conditions. Studies I and II relied on information from registers to operationalize downsizings/workplace closures, while Study III and IV obtained information about cognitive and affective job insecurity from the Longitudinal Occupational Survey of Health and the Swedish Work Environment Survey, respectively. According to Study I, employees who left the downsizing organization for another or no job increased their purchases of psychotropic drugs prior to the downsizing more than unexposed employees, while their purchases decreased in connection to the exits. For employees staying in the organization, psychotropic drug purchases increased from 1 year before the downsizing to 4 years after, particularly in close proximity to the downsizing. Study II showed that older employees exposed to downsizing/workplace closure before permanently exiting into old age retirement, sickness absence/disability pension or unemployment exhibited a smaller or no decline in psychotropic drug purchases during the period before or close to their exit, compared to unexposed employees exiting the labor market. Study III showed that the association between perceived job insecurity and incidence psychotropic drug purchases of any kind, were particularly pronounced for affective job insecurity, while cognitive job insecurity only increased the incidence of antidepressant purchases. In Study IV, exposure to cognitive job insecurity was associated with an increased risk of suicide mortality, but not with suicide attempts. In conclusion, exposure to employment uncertainty may increase the risk of clinically defined mental health conditions, for employees leaving or staying in an organization. Negative mental health consequences were particularly apparent when individuals reported a worry about their future job situation. Furthermore, involuntary job transitions later in life when invoked by downsizings/workplace closures may limit opportunities of improved mental health around the exit. These labor market conditions are common and closely connected to the business cycle as to why they may continue to affect the mental health of employees. In accordance with goals and agendas ratified by the Swedish government to see to conditions that hinder, or promote, a sustainable working life for everyone, employment uncertainty is one dimension worth acknowledging