Changes In Employment Status Research Articles

Within-person relationship between employment insecurity and mental health: a longitudinal analysis of the Understanding America Study

BackgroundEmployment insecurity is a socioeconomic factor influencing mental health, yet the empirical evidence supporting this claim has important limitations. The fluctuations in employment insecurity throughout the COVID-19 pandemic offered a...

Shifting employment and perceptions of household responsibilities during early stages of the COVID-19 pandemic in Nevada, USA.

Employment and household responsibility are critical health determinants. The COVID-19 pandemic altered the work and social landscapes in Nevada, USA through closures of workplaces and schools/childcare centers, changing patterns of employment, and household responsibilities. This study aimed to measure changes in employment status and perceived housework responsibilities among Nevada adults in December 2020, before widespread availability of COVID-19 vaccines in a pandemic-affected economy. Using a cross-sectional telephone survey of 1,000 Nevada adults, this study compared respondent experiences and perceptions of employment and time spent on housework in December 2020 to pre-pandemic using multinominal logistic, proportional odds, and logistic models. 70.52% of participants experienced no employment change; roughly 24% reported being fired/laid-off, working reduced hours, or quitting. Chi-square analyses found participants of color more likely than Whites to report being fired/laid-off or working reduced hours (p-value = 0.0005), though these findings were not significant in our models. Participants in the lowest income bracket had higher odds of being fired/laid off (p-value = 0.0030), and participants aged 65+ were less likely to experience employment change (p-value<0.0001). 32.43% of participants reported more time spent on housework. Multivariate analyses showed age is significantly associated with changes in both employment status (p-value<0.0001) and housework time (p-value<0.0001); income is a significant factor for employment status change (p-value = 0.0024). Of those reporting their households spent more time on housework, females were 2.90 times (95% CI = 1.66, 5.05, p-value = 0.0002) more likely to report taking on the additional work. Results demonstrate a disproportionate burden in employment change and/or more perceived household responsibilities on lower income and younger respondents, and females reporting they are more likely to take on additional housework. Understanding systemic vulnerabilities related to employment status and household responsibilities is necessary to aid impacted communities and to plan for future emergencies.

Interaction between alcohol intake and employment status changes on mortality among young workers

Abstract Background To investigate the impact of changes in employment status and their interaction with alcohol consumption on health outcomes among young workers. This study aims to explore how employment fluctuations, periodic unemployment, and economic activity levels influence the health of economically active individuals, focusing particularly on the synergistic effects that these employment changes may have when combined with alcohol consumption. Methods We conducted a retrospective cohort study using data from the Korean National Health Insurance Service database. The study included individuals aged 25-44 years who underwent health check-ups between 2009 and 2010. We categorized changes in employment status into three groups: continuously employed, economically active with employment fluctuations, and periodically unemployed. We estimated adjusted hazard ratios and 95% confidence intervals using multivariable Cox proportional hazard models to assess the impact of changes in employment status on the risk of all-cause mortality. The relative excess risk due to interaction, a widely accepted indicator of additive interaction, was used to assess the interaction between alcohol consumption and changes in employment status. Results Changes in employment status significantly increased the risk of all-cause mortality in both men and women in the economically active with employment fluctuations and periodically unemployed groups compared with the continuously employed group. The synergistic effect of alcohol consumption and changes in employment status on the risk of all-cause mortality was significant only among men. Conclusions The findings of this study indicate that changes in employment status, particularly when combined with alcohol consumption, significantly affect all-cause mortality among young workers. Key messages • Employment status fluctuations combined with alcohol consumption significantly increase all-cause mortality risks among young workers, especially men. • This study emphasizes the urgent need for targeted interventions that address the combined impact of employment and lifestyle factors on public health.

Assessment of healthy worker survivor bias among middle-aged manufacturing employees in Korea

Abstract Background Healthy Worker Survivor Bias (HWSB) describes a selection bias where those continuously employed tend to exhibit superior health outcomes compared to their unemployed counterparts. This bias challenges for adjustments due to its time-dependent nature. This study aims to evaluate the extent of HWSB related to changes in employment status among middle-aged manufacturing workers using comprehensive national data from Korea. Methods The study analyzed data from the National Health Insurance Service, targeting individuals aged 40-49 who maintained consistent insurance coverage-either as manufacturing employees or non-employees (self-employed or unemployed)-from 2008 to 2010. The observation period spanned from January 2011 to December 2022, with all-cause mortality as the primary outcome. We employed landmark analysis to quantify HWSB related to employment status by comparing age-standardized mortality ratios between employees and the general population from the initial assessment to the last landmark period (up to 7 years), calculating 95% confidence intervals (CI) using Poisson distribution. Results The cohort included 4,621,983 participants (726,616 manufacturing employees and 3,895,367 (84.3%) non-employees). Throughout an average follow-up of 10.9 years (43.1% male; median age of 44), there were 116,418 deaths (11,530 (1.6%) among manufacturing employees and 104,888 (2.7%) among non-employees). Analysis revealed a consistent linear increase in HWSB over time. Notably, the bias was more pronounced among females (7-year HWSB-ES [95% CI]: 0.27 [0.17-0.37]) compared to males (7-year HWSB-ES [95% CI]: 0.18 [0.14-0.22]). Conclusions This study quantifies the extent of HWSB among middle-aged manufacturing workers in Korea, highlighting its significant impact, notably in females. These findings are vital for occupational health research, emphasizing the necessity to consider HWSB to prevent the underestimation of health risks associated with hazardous exposures. Key messages • Findings suggest HWSB is more pronounced in female manufacturing workers, indicating the need for targeted occupational health interventions. • The study underscores the importance of accounting for HWSB in occupational health studies to avoid underestimating health risks associated with workplace exposures.

The effect of stress on liver function

«Psychosocial stress» is becoming an increasingly common concept in today’s complex and highly demanding society. Although the liver is one of the body’s most resilient organs, it is still vulnerable to the damaging effects of stress and aging, leading to liver disease, severe scarring and impaired function. Mental stress increases mortality from liver disease. Stressors activate macrophages and trigger an innate immune response, which then leads to the induction of inflammation and liver damage. In its diseases, symptoms such as low energy, fatigue, changes in employment status and functionality can also lead to the development of depression. The various physiological effects of glucocorticoids and catecholamines released into the bloodstream during stress lead to inflammation and oxidative stress in the liver. Research has explained the complex interactions that occur between stress system effectors and inflammation. Chronic psychological stress leads to an increase in serum glucocorticoid concentrations and the release of catecholamines, which increases the need for insulin. Insulin resistance leads to the development of metabolic-associated steatotic liver disease. The high prevalence of hepatogenic fatigue in chronic diffuse liver disease, its negative impact on the quality of life of patients, and the lack of effect of basic treatment lead to its aggravation due to stress. Sublingual S-adenosyl-L-methionine is effective in the treatment of hepatogenic stress fatigue, both in short-term and long-term use as part of the complex therapy of liver diseases.

Association of the COVID-19 Pandemic on Employment Status Change for Practicing Pharmacists

ObjectiveThe COVID-19 pandemic resulted in health care workers experiencing temporary or permanent changes in employment due to layoffs, quits, and postpandemic increased job demand. Analyzing the association of the COVID-19 pandemic with employment changes and results of changes for practicing pharmacists and understanding the associations with demographic and work-related factors could inform practice, policy, and educational programs. This study aimed to explore the frequency, characteristics, and results of employment status changes (ESCs) experienced by pharmacists practicing pharmacy in March 2020 (ie, the start of the COVID-19 pandemic). MethodsA descriptive, cross-sectional survey research design was used to collect data from a random sample of 93,990 licensed pharmacists in the United States. The study team developed an online survey questionnaire designed to assess the impacts of the COVID-19 pandemic on pharmacists’ work and work-life. The survey items used for this study related to ESCs, work-life characteristics, work characteristics in March 2020 and 2022, and demographic variables. A total of 4947 usable responses were received between November 2022 and January 2023. ResultsOverall, 36.4% of respondents reported experiencing an ESC and approximately 70% of those reporting an ESC reported experiencing just 1 ECS. Overall, 39.5% of respondents who experienced an ESC stopped working (ie, were unemployed) pursuant to an ESC. Respondents who experienced an ESC reported significantly lower levels of work exhaustion and interprofessional disengagement and significantly higher levels of professional fulfillment in their current employment than respondents that did not experience an ESC. ConclusionThe overall increase in demand for workers in the health care sector appeared to provide opportunities for pharmacists, especially pharmacists with 1 to 10 years of experience, to change their employment situation, resulting in better work-life characteristics. Given projections of a pharmacist shortage, research, policy, and educational programs could determine the best practices to improve work settings and the work-life characteristics of practicing pharmacists to improve the health of the current pharmacist workforce.

Association of the COVID-19 Pandemic on Employment Status Change for Practicing Pharmacists

ObjectiveThe COVID-19 pandemic resulted in health care workers experiencing temporary or permanent changes in employment due to layoffs, quits, and postpandemic increased job demand. Analyzing the association of the COVID-19 pandemic with employment changes and results of changes for practicing pharmacists and understanding the associations with demographic and work-related factors could inform practice, policy, and educational programs. This study aimed to explore the frequency, characteristics, and results of employment status changes (ESCs) experienced by pharmacists practicing pharmacy in March 2020 (ie, the start of the COVID-19 pandemic). MethodsA descriptive, cross-sectional survey research design was used to collect data from a random sample of 93,990 licensed pharmacists in the United States. The study team developed an online survey questionnaire designed to assess the impacts of the COVID-19 pandemic on pharmacists’ work and work-life. The survey items used for this study related to ESCs, work-life characteristics, work characteristics in March 2020 and 2022, and demographic variables. A total of 4947 usable responses were received between November 2022 and January 2023. ResultsOverall, 36.4% of respondents reported experiencing an ESC and approximately 70% of those reporting an ESC reported experiencing just 1 ECS. Overall, 39.5% of respondents who experienced an ESC stopped working (ie, were unemployed) pursuant to an ESC. Respondents who experienced an ESC reported significantly lower levels of work exhaustion and interprofessional disengagement and significantly higher levels of professional fulfillment in their current employment than respondents that did not experience an ESC. ConclusionThe overall increase in demand for workers in the health care sector appeared to provide opportunities for pharmacists, especially pharmacists with 1 to 10 years of experience, to change their employment situation, resulting in better work-life characteristics. Given projections of a pharmacist shortage, research, policy, and educational programs could determine the best practices to improve work settings and the work-life characteristics of practicing pharmacists to improve the health of the current pharmacist workforce.

Association of the COVID-19 Pandemic on Employment Status Change for Practicing Pharmacists.

The COVID-19 pandemic resulted in health care workers experiencing temporary or permanent changes in employment due to layoffs, quits, and postpandemic increased job demand. Analyzing the association of the COVID-19 pandemic with employment changes and results of changes for practicing pharmacists and understanding the associations with demographic and work-related factors could inform practice, policy, and educational programs. This study aimed to explore the frequency, characteristics, and results of employment status changes (ESCs) experienced by pharmacists practicing pharmacy in March 2020 (ie, the start of the COVID-19 pandemic). A descriptive, cross-sectional survey research design was used to collect data from a random sample of 93,990 licensed pharmacists in the United States. The study team developed an online survey questionnaire designed to assess the impacts of the COVID-19 pandemic on pharmacists' work and work-life. The survey items used for this study related to ESCs, work-life characteristics, work characteristics in March 2020 and 2022, and demographic variables. A total of 4947 usable responses were received between November 2022 and January 2023. Overall, 36.4% of respondents reported experiencing an ESC and approximately 70% of those reporting an ESC reported experiencing just 1 ECS. Overall, 39.5% of respondents who experienced an ESC stopped working (ie, were unemployed) pursuant to an ESC. Respondents who experienced an ESC reported significantly lower levels of work exhaustion and interprofessional disengagement and significantly higher levels of professional fulfillment in their current employment than respondents that did not experience an ESC. The overall increase in demand for workers in the health care sector appeared to provide opportunities for pharmacists, especially pharmacists with 1 to 10 years of experience, to change their employment situation, resulting in better work-life characteristics. Given projections of a pharmacist shortage, research, policy, and educational programs could determine the best practices to improve work settings and the work-life characteristics of practicing pharmacists to improve the health of the current pharmacist workforce.

Data profile: the Korean Workers' Compensation-National Health Insurance Service (KoWorC-NHIS) cohort.

The Korean Workers' Compensation-National Health Insurance Service (KoWorC-NHIS) cohort was established to investigate the longitudinal health outcomes of Korean workers who have been compensated for occupational injuries or diseases. This cohort study, which utilized data spanning from 2004 to 2015, merged workers' compensation insurance claim data with the National Health Insurance Database (NHID), encompassing 858,793 participants. The data included socio-demographic factors such as age, sex, income, address, insurance type, and disability grade. It also covered the types of occupational accidents, International Classification of Diseases, 10th revision codes for diseases or accidents, work tenure, industry, occupation code, and company size. Additional details such as the occupational hire date, date of claim, date of recognition, and affected body parts were recorded. The cohort predominantly consisted of male workers (80.0%), with the majority experiencing their first occupational accident in their 40s (27.6%) or 50s (25.3%). Notably, 93.1% of the cases were classified as occupational injuries. By integrating this data with that from the NHID, updates on health utilization, employment status, and income changes were made annually. The follow-up period for this study is set to conclude in 2045.

The Impact Of The Pre-Employment Card Program On Labor Force Participation In Indonesia (A Post-Covid-19 Analysis)

This study aims to examine the changes in labor absorption, particularly post-COVID-19, influenced by the Pre-Employment Card Program and sociodemographic characteristics. The main variable, the Pre-Employment Card Program, is analyzed based on recipients' status or those who have participated in training and received incentives. Sociodemographic characteristics include three variables: gender (using a dummy variable), education level (seven equivalent education levels), and age (25 to 44 years). Data from the National Labor Force Survey (Sakernas) for February 2022, conducted by the Central Bureau of Statistics (BPS) of Indonesia, is utilized. With a sample of 76,363 respondents aged 25 to 44 years, the study employs the binomial logit method to assess the influence of independent variables on changes in employment status. The results indicate that: a) the Pre-Employment Card Program has a smaller impact on employment compared to other variables, b) males are more likely to be employed than females post-pandemic, c) higher education levels increase the likelihood of employment, and d) older individuals are more likely to be employed or remain employed post-pandemic compared to younger individuals.

Exploring for the Change in Change of Employment Status Over Time

The study seeks to explore for presence of dissimilar developmental paths in employment status of American individuals. The empirical longitudinal exercise is conducted with hybrid latent class growth model and latent class growth mixtures. For testing the hypothesis of heterogeneous subgroups within employment status data three mainstream modelling variants of growth modelling are tested and elaborated in terms of model performance. Progressive employment status based typology is found robust to alternative model specifications voting for presence of clustered growth patterns in experiencing employment status over time. The resulted employment status based typology describes three clusters of active, inactive and mediocre active participants in terms of moving between various stages of employment status for the age span of 18years to 35 years i.e., from adult to post adult prime working life years. The presented approach to understand and explore employment status is novel perspective compared to classic survey based employment status data.

Impact of fatigue on work productivity and health-related job loss.

Fatigue is commonly reported in population surveys and has been identified in patients with health conditions as a key co-morbidity which makes remaining in work challenging. Such patients, however, rarely have access to programmes to help them manage their fatigue. To quantify the relationship between fatigue, work impairment and health-related job loss. We use data from the Health and Employment After Fifty study, a longitudinal study of people aged 50-64 years when recruited through general practices in England in 2013-14. During follow-up, fatigue was measured using the Fatigue Assessment Scale, work impairment was assessed using the Work Productivity and Activity Impairment scale, and changes in employment status were recorded. A total of 2743 participants were eligible for the current analysis; 23% satisfied criteria for being fatigued. People who were fatigued were less likely to have a partner, university degree, be physically active and were more likely to be obese. Their job was more likely to involve shifts, be perceived as insecure, have reported difficulties coping with job demands, and be unsatisfying. After adjustment for socio-economic, lifestyle and work-related factors, they were almost twice as likely to report both work impairment (relative risk 1.8; 95% confidence interval [CI] 1.6, 2.1) and future health-related job loss, although the latter effect was only in those with other morbidities (incidence rate ratio 1.96; 95% CI 1.03-3.72). Providing evidence-based support for workers with health conditions who experience fatigue may have an important impact at a population level in terms of extending working lives.

Exploring the workplace factors and their influence on the employment outcomes for people with multiple sclerosis

BackgroundHigh unemployment rate of people with multiple sclerosis (PwMS) is associated with substantial economic costs. Whilst the impact of MS symptoms and other disease-related factors on employment outcomes of PwMS has been assessed, limited evidence exists on the impacts of workplace factors. ObjectiveTo investigate the most common individual and group workplace factors associated with unemployment or a perceived risk of unemployment in PwMS, and to identify patient subgroups that are more susceptible to changes in employment status due to such factors. MethodsData from the Australian MS Longitudinal Study (AMSLS) on employment status and workplace factors were used. Fifteen workplace factors were classified under four groups: organisational, commuting, moving around at work, and equipment usage factors. Participants answered ‘Yes’ to each factor if it related to their unemployment and/or perceived risk of becoming unemployed and a group factor was considered “Yes” if at least one individual factor within it was answered as “Yes”. The proportions of “Yes” responses were calculated for both individual and group factors. Total number of individual factors was calculated and descriptive analyses and ordered logistic regression were used to summarize the total number of factors affecting each participant, and their association with participants’ occupations, sex, disability severity and disease duration. ResultsCommon workplace factors influencing employment were organisational (39.8 % perceived risk, 44.0 % lost employment), commuting (28.9 % perceived risk) and equipment usage difficulty (30.9 % lost employment). Common individual factors included inflexible working conditions, lack of suitable work, commuting difficulties, architectural barriers, and requirement to stand for long periods to use equipment. Professionals, blue-collar workers, and those with moderate/severe disability were more likely to report a higher number of workplace factors risking their employment. ConclusionsWorkplace factors undermine PwMS employment, with variations among subgroups based on occupation and disability severity. Understanding these barriers is crucial for supporting PwMS in the workforce.

Traumatic Cervical Spinal Cord Injury and Income and Employment Status

Spinal cord injury (SCI) causes drastic changes to an individual's physical health that may be associated with the ability to work. To estimate the association of SCI with individual earnings and employment status using national administrative health databases linked to income tax data. This was a retrospective, national, population-based cohort study of adults who were hospitalized with cervical SCI in Canada between January 2005 and December 2017. All acute care hospitalizations for SCI of adults ages 18 to 64 years were included. A comparison group was constructed by sampling from individuals in the injured cohort. Fiscal information from their preinjury years was used for comparison. The injured cohort was matched with the comparison group based on age, sex, marital status, province of residence, self-employment status, earnings, and employment status in the year prior to injury. Data were analyzed from August 2022 to January 2023. The first outcome was the change in individual annual earnings up to 5 years after injury. The change in mean yearly earnings was assessed using a linear mixed-effects differences-in-differences regression. Income values are reported in 2022 Canadian dollars (CAD $1.00 = US $0.73). The second outcome was the change in employment status up to 5 years after injury. A multivariable probit regression model was used to compare proportions of individuals employed among those who had experienced SCI and the paired comparison group of participants. A total of 1630 patients with SCI (mean [SD] age, 47 [13] years; 1304 male [80.0%]) were matched to patients in a preinjury comparison group (resampled from the same 1630 patients in the SCI group). The mean (SD) of preinjury wage earnings was CAD $46 000 ($48 252). The annual decline in individual earnings was CAD $20 275 (95% CI, -$24 455 to -$16 095) in the first year after injury and CAD $20 348 (95% CI, -$24 710 to -$15 985) in the fifth year after injury. At 5 years after injury, 52% of individuals who had an injury were working compared with 79% individuals in the preinjury comparison group. SCI survivors had a decrease in employment of 17.1 percentage points (95% CI, 14.5 to 19.7 percentage points) in the first year after injury and 17.8 percentage points (14.5 to 21.1 percentage points) in the fifth year after injury. In this study, SCI was associated with a decline in earnings and employment up to 5 years after injury for adults aged 18 to 64 years in Canada.

Public opinion, racial bias and labour market outcomes in the USA.

Here we study the role of negative shifts in public opinion in the economic lives of under-represented racial groups by investigating sudden changes in views towards Asian people following the anti-Chinese rhetoric that emerged with the COVID-19 pandemic, and associated changes in employment status and earnings in the US labour market. Using data from the Current Population Survey, we find that, unlike other under-represented groups, Asian workers in occupations or industries with a higher likelihood of face-to-face interactions before the pandemic were more likely to become unemployed afterwards. While widespread along the political spectrum, negative shifts in the perceived favourability of Asian people, and not of other under-represented groups, were much stronger among those who voted for Donald Trump in 2016 and could have been more influenced by the anti-Asian rhetoric.

Challenges in Medicine, Magnified by the Pandemic: A Dual Battle for Female Physicians.

We aimed to understand how the pandemic impacted work hours and employment status of female physicians. Methods: An anonymous survey of female physicians was distributed through social media and email lists from 12/2021 to 2/2022. Primary outcomes were changes in physicians' work schedules and employment status. Analyses included descriptive statistics of closed-ended items and qualitative content analysis of open-ended responses. We restricted our analysis to four specialties: obstetrics and gynecology, internal medicine, anesthesia, and pediatrics (n=626). The majority (92%) of respondents had caretaking responsibilities; 43%changed work schedules to accommodate those responsibilities. Around 17% of physicians changed jobs. The most common reasons for job changes included: negative work environment, lack of work-life balance, burden of work, and lack of efforts to mitigate COVID-19. Conclusion: The pandemic highlighted the need for flexibility, improvements in workplace culture, and financial incentives to increase retention.

Assessment of the socioeconomic impact of COVID-19 in Rwanda: Findings from a country-wide community survey, preliminary analysis to inform further global research

RationaleThe COVID-19 pandemic along with its devastating impact on human lives has disrupted the socioeconomic situation worldwide. Rwanda has adopted lockdowns and other measures to prevent the spread of the COVID-19 pandemic. Recent studies documented the macro-level socio-economic pandemic impact but the impact on a household’s daily life has been scarcely documented especially in low-and-middle-income countries. ObjectiveThis work describes the interplay between multiple factors to assess the socio-economic impact of COVID-19 on the Rwandan population at the micro-level (household). MethodsData from a country-wide community survey conducted in Rwanda between December 2021 and March 2022 were used. A total of 26,412 response forms were received from around 4400 participants surveyed in 6 recurrent bi-weekly phases where participants were randomly selected. The Multivariable Logistic regression model was fitted to data with a backward stepwise elimination algorithm to assess the socioeconomic impact of COVID-19 on households’ income. Factors considered in this study are gender, age group, residence, level of education, occupation, change in employment status, socioeconomic status, and marital status. ResultsThe multivariable logistic regression model provided the factors associated with the decline in income due to COVID-19. The results show that people living without a partner are more likely to experience income decline due to COVID-19 than people living with their partner. It is seen that the higher the number of children in a household, the higher the risk of experiencing a decrease in income. Taking into consideration the education level and comparing people with post-secondary and university level vis-a-vis people who did not attend school, the latter are 27 times more likely to experience a decrease in their income, those who attended primary school are 5 times more likely to experience a decrease in income, and those who attended secondary school are almost 2 times more likely to experience a decrease in income. ConclusionsThe findings from this research will be used by policymakers and other stakeholders to design and implement preventive and responsive measures for future pandemics that should be multifactorial and tailored to transversal parameters like gender and residence.

Perceived Mental and Physical Health During the Pandemic: The Role of Financial Stress

This study uses the double ABC-X model to explore the link between COVID-19-induced stressors and health outcomes. Analyzing a unique online survey of 2,290 respondents in 2021, our results suggest that the process behind the relationship between financial strain and health is nuanced where financial stress plays an important role. Specifically, the results reveal that changes in income, employment status, and expectations regarding future income significantly affect perceived mental and physical health, with financial stress acting as a significant mediator. Our findings imply that financial counseling could be more effective if the client’s idiosyncratic coping mechanisms such as their financial stress are incorporated in the practice beyond quantitative analyses. Our findings provide directions for future research, as well as implications for financial counselors, healthcare providers, and policymakers.

Longitudinal determinants of employment status in people with relapsing-remitting multiple sclerosis

PurposeTo investigate longitudinal relationships between employment status and disease-related, (neuro)psychological, and work-related factors in people with multiple sclerosis (MS). Methods170 employed people with MS underwent yearly neurological and neuropsychological examinations to assess MS-related disability and cognitive functioning. Additionally, they completed yearly questionnaires assessing depression, anxiety, fatigue, cognitive complaints, workplace support and coping. Multilevel models for change were fitted to examine progression of these factors over three years, and to assess possible relationships with change in employment status. ResultsPeople with a deteriorated employment status after three years reported more depression (p=0.009), a higher impact of fatigue (p<0.001), more cognitive complaints (p<0.001) and less workplace support (p=0.001) at baseline than people with a stable employment status. There were no differences in progression over time of the examined variables between people with a stable or deteriorated employment status. ConclusionMore depression, a higher impact of fatigue, more cognitive complaints and less workplace support are predictive of a deteriorated employment status after three years in individuals with MS. How these factors progress over time is not different between those with a stable or deteriorated employment. MS-related disability, anxiety, objective cognition and coping were not related to a deterioration in employment status.

Change in employment status and its causal effect on suicidal ideation and depressive symptoms: A marginal structural model with machine learning algorithms.

This study aimed to assess the causal effect of a change in employment status on suicidal ideation and depressive symptoms by applying marginal structural models (MSM) with machine-learning (ML) algorithms. We analyzed data from the 8-15th waves (2013-2020) of the Korean Welfare Panel Study, a nationally representative longitudinal dataset. Our analysis included 13 294 observations from 3621 participants who had standard employment at baseline (2013-2019). Based on employment status at follow-up year (2014-2020), respondents were classified into two groups: (i) maintained standard employment (reference group), (ii) changed to non-standard employment. Suicidal ideation during the past year and depressive symptoms during the past week were assessed through self-report questionnaire. To apply the ML algorithms to the MSM, we conducted eight ML algorithms to build the propensity score indicating a change in employment status. Then, we applied the MSM to examine the causal effect by using inverse probability weights calculated based on the propensity score from ML algorithms. The random forest algorithm performed best among all algorithms, showing the highest area under the curve 0.702, 95% confidence interval (CI) 0.686-0.718. In the MSM with the random forest algorithm, workers who changed from standard to non-standard employment were 2.07 times more likely to report suicidal ideation compared to those who maintained standard employment (95% CI 1.16-3.70). A similar trend was observed in the analysis of depressive symptoms. This study found that a change in employment status could lead to a higher risk of suicidal ideation and depressive symptoms.