Productive activities, mental functioning and well-being in disability: Exploring the role enhancement and the role strain hypotheses

Abstract

Background Engagement in productive activities is an important determinant of mental functioning and well-being. Persons with physical disabilities are often confronted with constraints to engage in productive activities and it remains largely unknown whether persons who nevertheless manage to be productive experience beneficial effects for mental functioning and well-being. This is the first study to analyse different productive activities (paid work, volunteering, education, housework) and its gender-specific associations with mental functioning and well-being in the disability setting, testing two contrasting hypotheses of Role Theory, the role strain and the role enhancement hypotheses. Methods We used data from a representative sample of 1157 men and women of employable age who sustained a severe physical disability (spinal cord injury). Load of engagement in paid work, volunteering, education, and housework was classified into three groups (none; moderate; high). To assess the total productivity load, a score over the four items was calculated. Diversity of engagement in productive activities was assessed with variables on the number and combination of activities. Tobit regressions were applied to evaluate associations of load and diversity of engagement in productive activities with mental functioning (Mental Health Inventory, SF-36) and well-being (WHOQoL-BREF items). Results We found that the total productivity load and the load of paid work were positively related to mental functioning and well-being in men. Individuals with moderate engagement in volunteering reported better mental functioning (both genders) and well-being (in women) than those with higher or no engagement. Our results support the role enhancement hypothesis, as mental functioning (in men) and well-being (both genders) increased with the number of performed activities. In men who had paid work, mental functioning and well-being increased consistently with each additional unpaid activity. In contrast, engagement in paid work played a minor role for mental functioning and well-being in women. Conclusion This study in the disability setting provided clear support for the role enhancement hypothesis. Future research on the mechanisms behind the observed associations is warranted to develop interventions and policies that strengthen resources important for engagement in productive activities as well as for mental functioning and well-being in persons with physical disabilities.