The mental health burden of the economic crisis in Europe: the role of job insecurity and displaced workers

Background The recent economic crisis is characterized by rising unemployment. Especially the group of displaced workers has increased, as many Europeans have lost their job due to plant or business closures. Additionally, long-term employment in the same job has already become relatively rare, while temporary or contract-based job opportunities and more flexible use of labor are increasing. The latter changes, combined with rising unemployment rates, have led to a heightened sense of job insecurity. Concerns have been raised about mental health problems and care use, as research has related job insecurity and unemployment to worse mental health and a greater use of health care services and psychotropic drugs. The impact of this economic crisis differs from country to country. With the exception of Ireland and Iceland, the biggest tremors in Europe have been felt in the Southern countries. Differences in the strength of the crisis have also been observed within countries, as reflected in the large variance in regional unemployment rates. Most research to date has focused on the comparison process of being unemployed in the context of a high or low level of unemployment, while rarely on the cause of unemployment. However, based on the social norm theory, being unemployed because of a workplace closure can also be experienced in a different way to being unemployed under other circumstances, such as being laid off due to personal reasons. The former–the displaced workers–are characterized by a structural cause for the displacement. This kind of unemployment can be considered as exogenous to the individual. It can be perceived as a structural and social problem rather than an individual issue, given that the unemployed person will not be the only one in that situation and they might compare themselves with colleagues who also lost their job. As a result, their unemployment may be perceived less as a personal failure and affect the worker less in terms of self-blame and self-esteem, which may have consequences for their mental health, as well as for their mental health care, and medication use. Moreover, these differences in experience of unemployment also enable us to test the medicalisation hypothesis empirically. Medicalisation describes a process in which problems that are not self-evidently medical–such as unemployment and job insecurity–are defined and treated as medical problems. Researchers have warned that unemployment could be isolated from its social roots by considering it as a personal characteristic rather than a social process that influences the risk factors for illness. Based on the social norm theory, unemployment due to a non-structural cause will possibly trigger medicalisation more than unemployment with a structural cause, as the latter will be less individualized and perceived less as deviant or a personal problem that needs medical treatment Objective This study aims to investigate the relationships between employment status and mental health, mental health care, and medication use, paying attention to the regional unemployment level, and using the social norm and medicalisation perspective as theoretical framework. With regard to unemployment, we investigate whether the relationships differ for the ‘displaced workers’. For those still in the labour force, we scrutinize the impact of job insecurity. In addition, attention will be paid to possible gender-related differences in these relations. We focus on the group of aged 50 plus who are still included in the labour force. They are an interesting research population in the European context of an aging population together with active aging policies, which envisage the enhancement of health as well as social and labour-market participation. During economic instability, young people and older people are especially vulnerable to marginalisation in the labour-market. When people aged over 50 become unemployed, the chances of them finding a new job are low. In addition, research indicates that the middle and older aged unemployed are more depressed than those who are younger. Data and methods Data is used from the fourth wave of the Health Ageing and Retirement (SHARE) survey, which includes information on individuals aged 50 years or above, after the onset of the global financial crisis (2010-2012). A subpopulation of individuals between 50 and 65 years old (men N=11,789 and women N=15,118) is selected. Our hypotheses are tested by means of 3-level multilevel analyses -(1) individuals, (2) regions (NUTS) and (3) countries- with psychiatrist consultations, number of the number of consultations with a general practitioner (GP) and medication use for anxiety and depression, as main dependent variables. Gender-specific indicators of mental health are used to take the extent of distress by gender into account, as women suffer more from anxiety and depressive disorders, while men suffer more from impulsive and addictive problems, such as alcohol consumption. Anxiety and depressive symptoms is measured by the EURO-D 12-item scale and Heavy episodic drinking (HED) is defined as drinking at least 60 grams (alcoholic drinks) or more of pure alcohol on at least one occasion in the seven days prior to the survey. Results and discussion In line with the social norm theory, the results show that–only for men–the displaced workers are less depressed and use less medication compared with the non-displaced unemployed. However, they report more depressive symptoms than the employed, which supports the causation effect of unemployment. We find evidence for the medicalisation of unemployment, but not of job insecurity, among men and women in terms of respectively psychiatrist and general practitioner consultations. Only the non-displaced unemployed men seem to be triggered to medicalise their unemployment by consuming medication. Few associations are found between the regional level of unemployment and health care use by the unemployed. Only unemployed men in a region with a higher unemployment rate have a lower number of GP consultations compared with the unemployed in a region with a low level of unemployment. This is also irrespective of their mental and general health. This finding can be considered as an indication of the social norm effect of unemployment among men, but on the regional level