Abstract
The health and human care workforce comprise a substantial and increasing proportion of the employed population in high income countries. This diverse workforce is comprised of high skilled workers, such as doctors and nurses, as well as lower skilled workers such as carers and support workers. This paper assessed psychosocial working conditions among health and human care workers compared to other workers. We also examined the effects of psychosocial working conditions on mental health. The data source was 16 waves of the Household Income Labour Dynamics in Australia survey. The exposure was a multidimensional, previously validated psychosocial job quality index. The outcome was changes in the Mental Health Inventory-5 (MHI-5). The effect modifier was a multicategory health and human care occupational variable. Random and fixed effects linear regression models were used to unpack between- versus within- person differences. Time varying confounders were controlled for. We found evidence of effect modification. Carers and support workers experienced a 4.90-point decline (95% CI −6.23 to 3.57) on the MHI-5 when reporting 3 or more job stressors compared to no stressors. These workers also reported lower levels of mental health than other occupational groups and had greater exposure to poor psychosocial working environments. Health workers also reported substantial declines on the MHI-5 when exposed to 3 or more job stressors (−3.50, 95% CI −5.05 to −1.94). Understanding the quality of employment in this workforce, and consequent impacts of this employment on mental health is critical to ensuring sustainable individual, organizational and client-related outcomes.
Highlights
Across high-income countries, the ageing population and increasing burden of mental health problems has increased the demand for health and human service work (Rechel et al, 2009)
This showed that job insecurity had the biggest effect on mental health across all occupational groups (Other workers: Coef. −3.73, 95% CI −4.01 to −3.44, p < 0.001; Carers and support workers: Coef. −4.16, 95% CI −5.07 to −3.26, p < 0.001; Health care workers: Coef. −3.08, 95% CI −4.53 to −1.64, p < 0.001; Human service workers: Coef. −3.59, 95% CI −3.96 to −3.22, p < 0.001)
The results of this study suggest that lower skilled carers and support workers were more likely to be exposed to psychosocial job stressors than higher skilled health workers such as doctors and nurses
Summary
Across high-income countries, the ageing population and increasing burden of mental health problems has increased the demand for health and human service work (Rechel et al, 2009). A recent review on healthcare aides (paid caregivers for persons with disabilities and older persons) highlighted poor pay, lack of clarity of work roles and job insecurity as risk factors for occupational injury and turnover (Hewko et al, 2015) This may be different from higher-skilled hospital nurses and physicians, where other stressors including low control, high demands and lack of social support have been identified as prominent job stressors (Weigl et al, 2013). Nurses and social workers had a significantly elevated risk of developing an affective disorder (Wieclaw et al, 2006) This present study seeks to advance knowledge about working conditions and mental health among the health and human service workers using a longitudinal research design. The paper will assess how much of the relationship between psychosocial working conditions and changes in mental health may be due to within person effects, providing stronger evidence about the role of psychosocial working conditions on changes in mental health
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