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Seria wydawnicza EUKRASIA Vol. 5 Unemployment and Health Care |
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Ramune Kalediene, Jadvyga Petrauskiene, Mindaugas Stankunas ASSOCIATIONS BETWEEN UNEMPLOYMENT AND MENTAL HEALTH DURING THE PERIOD OF SOCIO-ECONOMIC TRANSITION IN LITHUANIA Fourteen years have passed since Lithuania declared independence in 1990. Newly independent country faced many challenges in transformation of political, social, and economical systems. The transition from planned economy to market economy caused an increase of competition, rise of private capital, and changes in labour market with growing unemployment. G. Dahlgren et al. refer, that unemployment is one of the factors, having considerable influence to the health of population [1]. Many studies have shown that becoming jobless and long-term unemployed may increase the risk of premature death [24] and have adverse effects on physical, and especially mental health [57]. These associations are largely assumed to be mediated through psychological stress [8], which leads to the negative lifestyle changes [9]. Alcohol drinking [10], smoking [6], drug use, suicide intentions, and crime [11] are more expressed among unemployed persons. It could be expected, that similar associations between unemployment and health exist in Lithuania as well. However, there were no studies on health and unemployment carried out in Lithuania up till now. The aim of our study was to assess the levels and trends of unemployment and mental health indicators in Lithuania during the first decade of independence and to explore the possible explanations of these associations. Methods The period under investigation is the first decade of independence of Lithuania, 19902001. Information about unemployment level was derived from computerized database STAS 1.1 obtained from Lithuanian Department of Statistics, and Lithuanian Labour Market (LLM). Unemployment level represents the percentage of unemployed persons who are listed in the Register of LLM from all country labour force. Information on deaths and mental health was obtained from computerized information system of Lithuanian Health Information Centre. Incidence and prevalence of mental disorders (codes of the International Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10): F00-F99), incidence of mental diseases (ICD-10: F00-F09, F20-F99), incidence of psychosis (ICD-10: F00-F09), incidence of schizophrenia (ICD-10: F20-F29), and alcohol psychosis (ICD-10: F10) were included in the analysis. Mortality from suicides (ICD-10: X60-X84), and from selected alcohol related causes (cancers of oesophagus and larynx (ICD-10: C15, C32), alcohol psychosis, chronic liver disease and cirrhosis (ICD-10: K70, K73-74, K76), and all external causes (ICD-10: V00-V99, W00-W99, X00-X99, Y00-Y99), numbers of road traffic accidents involving one or more persons under influence of alcohol and with personal injuries and incidence of drug abuses (number of persons which were admitted for the first time for the treatment related to drug abuse) were included in the study as well, as related to mental health of the population. Mortality rates and mental health indicators were calculated per 100 000 population, mortality rates were age-standardized using European standard as recommended by World Health Organization. The model of logarithmic regression was used to evaluate the trends in mortality, morbidity, and unemployment: log rt = a + bt + et where: rt unemployment, morbidity and mortality (standardized) rates; log logarithm; t year; et error; b coefficient of logarithmic regression, which presents average annual change (multiplied by 100, was presented as the average annual change in percents). Correlation (r) between the level of unemployment and mental health indicators was estimated. The differences between two rates were assessed using Student (t) criteria. The difference was considered as significant at p<0.05 level. Results Until the early 1990s, the unemployment rate in Lithuania was very low (about 1%). However, by late 1992, the unemployment rate started to increase and by the end of 1996 had climbed up to 7%. In the summer of 1997, Lithuanian Government passed the law, by which the minimal salary has been increased from 330 to 400 LT (approximately 100 USD). This regulation made the workforce more expensive, and could be the cause of the sudden unemployment increase, reaching the peak of 13% in the early 2001. An unemployment rate varied between administrative regions. The highest unemployment rate on March 1, 2001 was registered in Lithuanian resort town Druskininkai (29%), Akmene (24.1%) and Pasvalys (23.9%) regions. Lower than countrys unemployment rate was observed in sixteen administrative regions, mainly more urbanized areas. Among the major cities of Lithuania, the capital of the country Vilnius witnessed the lowest unemployment level 9.2%. Generally, women made up 44.8%, men 55.2% of the unemployed. Young people aged under 25 made up 14.5%. Approximately 13% of the unemployed persons received unemployment benefits. Prevalence of mental disorders was 4.3% or 159 178 total number of cases in Lithuania in 1990. During the period of 19901993, this rate was decreasing, and in 1993, 3.9% of population was reported as having mental disorders. Since 1994, prevalence of mental diseases was growing and reached 4.7% in 2001. This trend coincided with the trend of unemployment (fig. 1). The significant decline from 462 to 361 per 100 000 new cases of mental disorders was observed in 19901993, which was followed by sharp increase until 1995, reaching the level of 493 per 100 000. In 1996-2001, less new cases of mental disorders were registered, and in 2001 the incidence was 317 per 100 000 (tab. I). However, the different situation was observed in the morbidity of mental diseases. The new cases of mental diseases were growing in 19901992. Later, there were no significant changes, until extremely sharp increase in 1998. The significant increase was registered in the incidence of psychosis, schizophrenia, alcoholic psychosis, and drug abuses. Suicide is very specific cause of death, which reflects indirectly hopelessness about the future, severe depression or mental illness. Suicide rate in Lithuania increased from 31.2 per 100 000 in 1990 to 46.8 per 100 000 in 1995. During the period of 19962001, slight decline was observed; however, it is still among the highest in Europe [12]. Fig. 1. Unemployment rate and prevalence of mental disorders during 19902001. Table I. The changes in unemployment rate (%) and incidences of mental health indicators (per 100 000 inhabitants) during the period 19902001 in Lithuania
b average annual change of the indicator Though alcohol related mortality rate and mortality from traffic accidents involving alcohol are not direct mental health indicators, nevertheless they reflect in some way mental health. Considerable increase in mortality from selected alcohol related causes registered during the period of 19911994 (165 per 100 000 in 19991 and 235.1 per 100 000 in 1994), was followed by decline until 2001, reaching the same level as it was in 1991. The numbers of traffic accidents involving alcohol decreased from 31.1 in 1991 to 19.6 in 1995 per 100 000 population, and started to increase later. The time trends of the unemployment and selected mental health indicators were compared. The average annual change of unemployment rate was 30.6% (p<0.001). Similar trends were observed in incidences of mental diseases (b=11.6%), schizophrenia (b=7.4%), alcoholic psychosis (b=8.5%), and drug abuses (b=18.8%) (tab. I). Changes in mortality from suicides, selected alcohol related causes, incidences of mental diseases and psychosis were not statistically significant. Strong and statistically significant correlations between unemployment level and prevalence of mental disorders (r = 0.87), incidences of mental diseases (r = 0.79), schizophrenia (r = 0.77), and drug abuse (r = 0.78) were observed. Nevertheless, unemployment did not correlate with psychosis, alcohol psychosis, suicides, and traffic accidents involving alcohol (tab. II).
Table II. The correlation coefficients
between unemployment and selected
Discussion Our study encompassed an important period in the development of Lithuania, involving a shift from being a Soviet Republic to that of being an independent state with newly developing market economy. Since the beginning of the political and economic reforms in 1989, and after the collapse of the Soviet Union, circumstances in Lithuania have changed dramatically and the population of the country has been exposed to a new unfamiliar social environment, experiencing stress because of fundamental economic, political, and social changes. Economic changes privatisation, multiple closures of factory, shifting to market economy, and negative changes in trade balance caused increase of unemployment. Rapidly rising unemployment rates had considerable impact on peoples everyday lives. The overall economic, social, and psychological effects of the transformations were immense, which makes the evaluation of mental health data extraordinary valuable. Results from various studies suggests, that in the countries with enduring unemployment, the increased frequency of the following health effects should be anticipated: 1) psychosomatic diseases; 2) neurosis, psychic distress, behavioural disturbances; 3) suicide attempts, fatalities; 4) other health effects [13]. Therefore, in the present study we concentrated on investigations of associations between mental health and unemployment. Incidences of mental disorders, mental diseases, psychosis, schizophrenia, alcohol psychosis and prevalence of mental disorders we considered as indicators, reflecting the status of mental health. Mortality from suicides, and selected alcohol related causes, as well as number of traffic accidents involving alcohol and incidence of drug abuses were included in the study as indicators, presenting the possible outcomes of ill mental health. Unemployment is one of the main factors reflecting on the economic and social situation in country. Lithuanian Labour Market collects and analyses the movement of labour force in Lithuania. However, the official unemployment data can carry an underestimation of their real number job-less individuals may not be included in the register of LLM, or they might work illegally. Various cross-sectional studies suggest that real number of unemployment is 22.5 higher in comparison with official statistics [1415]. Our study argues that unemployment has direct effect on population mental health. From other studies there are also results showing that unemployment has an impact on mental health [1618]. In addition, re-employment has been reported to be associated with two effects on mental health: with a reduction of mental ill health [19], and with no changes in mental health [20]. The correlation between unemployment and mental health could be explained according to estimation, that unemployment is one of the most stressful life events, which lead to lowered social status, disrupts family and social roles, and causes loss of self esteem, all of which have detrimental consequences for mental health [21]. Findings from other studies indicate, that the unemployed suffered from high financial deprivation, compared with their own subjective standards, their situation when working, their neighbours and friends and the average of population, which was closely related to mental health problems [22]. The problematic link unemployment financial strain distress / ill mental health is expected to be extremely severe in Lithuania. Only 13% of the unemployed persons received unemployment benefits. Moreover, this benefit is too small (approximately 90 USD per month) for covering minimal daily expenses. The Warrs vitamin model points that there are nine elements (opportunity for control, opportunity for skill use, externally generated goals, variety, environmental quality, availability of money, physical security, opportunity for interpersonal contact and valued position) which are essential for mental health and well-being. This model suggests more holistic explanation how unemployment effects mental health. Following his theory, unemployment leads not only to loss of income, but also to a loss of other desirable elements important for mental health, which cause the adverse effect on mental health [23]. As it was discussed above, the unemployment causes financial strains. Economic problems may lead to a change in social status, increased psychological stress, and impaired self confidence, which in turn causes variety of coping behaviours that may have mental and physical health consequences [24]. Therefore, indicators presenting the hazard behaviour for mental health have been analysed in our study. We have found strong correlation between unemployment and drug abuse, however no statistically significant associations between alcohol psychosis and unemployment. Previous studies in other countries support the link between drug abuse and unemployment [25,26]. Nevertheless, studies give some inconsistencies in the results concerning unemployment and alcohol consumption. There are studies reporting that loosing a job may increase alcohol consumption [27], while other researchers have failed to show any such association [28]. There are even examples of reduced levels of alcohol consumption associated with unemployment [19,29]. Unemployment may lead to reduced alcohol consumption due to economic difficulties as well as an increase due to more leisure time and a need for alcohol as sedative [19]. Khan et al. conclude that recent unemployment decreases alcohol use while longer unemployment increases it [30]. Returning to alcohol psychosis and alcohol abuse in Lithuania, it is important to discus the prevalence of alcohol abuse in Lithuania. The results of International study FINBALT Health Monitor showed that using strong alcohol at least once a week increased during the last decade in Lithuania [31,32]. A binge drinking culture exists in Lithuania. Binge drinking at least once a week was reported by 18.0% on men and 1.9% of women. Although the officially reported level of alcohol consumption was around 9.5 l of pure alcohol per person in 1995 [33], it has been estimated that up to 6065% of the alcoholic beverage market was illegally produced or imported [34]. Therefore, it could be expected that the alcohol related problems in Lithuania are more severe as it is presented in official statistics. Exclusion of this information bias could lead to the increase of correlation between alcoholic psychosis and unemployment. Suicide is closely associated with unemployment [35,36]. Three explanations are possible [37,38]: unemployment may confer vulnerability by increasing the stressful life events; it may indirectly cause suicide by increasing the risk of factors that precipitate suicide (for example mental illness, financial difficulties); or it may be non-causal association because of confounding or selection by factors that predict both unemployment status and suicide risk [39]. Several studies have revealed increased rates of suicide during periods of economic recession and high unemployment rates [40,41]. Unemployment rate was gradually increasing in Lithuania throughout the period of investigation, reaching the highest level (13.1%) in 2001. Nevertheless, our results demonstrated that during the period of the most intensive increase in unemployment, suicide rates were decreasing since 1995. Similar phenomenon was reported in Latvia, suggesting that relationship between unemployment and suicide is very complex and not typical both in Latvia and Lithuania some other factors play more important roles on the levels of suicide in these countries [42]. Considerable mental health problems require particular attention in Lithuania. Our study suggested that unemployment plays an important role in it. Collective actions should be facilitated to address the challenges of unemployment. Improvement could be achieved, if strong pressure was put on the Government, municipal authorities and health services to take action on health of the unemployed. Among the many opportunities to achieve this goal is investment in human capital, redistributive policies, and ensuring comprehensive access to health care. Mental health of the unemployed should receive serious attention in health policy development in Lithuania. Despite limited resources, mental health could be improved not only through health care services, but also through social reforms. For evaluation of unemployment effect on mental health further studies should be carried out in Lithuania. The attention should be paid to evaluation of the unemployment effect on individual level, performing qualitative investigations as well. Coming studies should increase understanding of mental health broader and cover elements such as sense of coherence, shame, and ability to cope. Our study can serve as a background research for in-depth analysis of unemployment and health associations in Lithuania. Conclusions Unemployment rate was gradually increasing in Lithuania throughout the period of 19902001. Similar trends were observed in incidences of mental diseases, schizophrenia, alcoholic psychosis, and drug abuses. Strong and statistically significant correlations were observed between unemployment level and prevalence of mental disorders, incidences of mental diseases, schizophrenia, and drug abuse. Only through common efforts of social support and health care systems, the effects of unemployment on mental health could be reduced.
REFERENCES [1] Dahlgren G., Whitehead M.: Policies and strategies to promote equity in health. Institute for Future Studies, Stockholm, 1991. [2] Martikainen P.T.: Unemployment and mortality among Finnish men, 19811985, BMJ 1990, 301, 407411. [3] Morris J.K., Cook D.G., Shaper A.G.: Loss of employment and mortality. BMJ 1994, 308, 11351139. [4] Martikainen P.T., Valkonen T.: Excess mortality of unemployed men and women during a period of rapidly increasing unemploy-ment. Lancet 1996, 348, 909912. [5] Murphy G.C., Athanausou J.A.: The effect of unemployment on mental health. Journal of Occupation and Organization Psychology 1999, 72, 8399. [6] Janlert U.: Unemployment as a disease and diseases of the unemployed. Scand J Work Environ Health 1997, 23 suppl. 3, 7983. [7] Viinamaki H., Kosela K., Niskanen L.: The impact of unemployment on psychosomatic symptoms and mental well-being. The International Journal of Social Psychiatry 1993, 39, 266273. [8] Bartley M. et al.: Socioeconomic determinants of health. Health and the life course: why safety nets matter. BMJ, 1997, 314, 1194. [9] Laitinen J., Ek E., Sovio U.: Stress-related eating and drinking behaviour and body mass index and predictors of this behaviour. Prev. Med. 2002, 34(1), 2939. [10] Mullahy J., Sindelar J.: Employment, unemployment, and problem drinking, J Health Economics 1996, 15, 409434. [11] Fergusson D.M., Horwood L.J., Woodward L.J.: Unemployment and psychosocial adjustment in young adults: causation or selection? Soc. Sci. Med. 2001, 53, 305320. [12] WHO Health for All 2003 Data Base. WHO, Copenhagen. [13] Ungvary G., Morvai M., Nagy I.: Health risk of unemployment. CEJOEM 1999, 5, 91112. [14] Report on human social development in Lithuania, 1998. Vilnius 1998. [15] Nordic/Baltic Social Protection Statistics 2000. NOSOSCO Nordic Social Statistical Committee 119, 2003. [16] Kraut A., Mustard C., Walld R. et al.: Unemployment and health care utilization. Scand J Work Environ Health 2000, 26,169177. [17] Mathers C.D., Schofield D.J.: The health consequences of unemployment: the evidence. MJA 1998, 168, 178182. [18] Gien L.T.: Land and Sea Connection: The East Coast Fishery Closure, Unemployment and Health. Can J Public Health 2000, 91, 121124. [19] Kasl S.V., Jones B.A.: The impact of job loss and retirement on health:. In Berkman L.F., Kawachi I. ed. Social epidemiology. New York, Oxford: Oxford University Press, 2000, 118136. [20] Halvorsen K.: Impact of re-employment on psychological distress among long-term unemployed. Acta Sociologica 1998, 41, 227242. [21] Ensminger M.E., Celentano D.D.: Unemployment and psychiatric distress: social resources and coping. Soc. Sci. Med. 1988, 27, 239247. [22] Underlid K.: Personal financial situation during unemployment and mental health. Scand. J. Soc. Welfare 1997, 6, 212. [23] Warr P.B.: A conceptual framework for the study of work and mental health. Work and Stress 1994, 8, 8497. [24] Voss M.: Work and health. Epidemiological studies of sickness absence and mortality with special reference to work environment, factors outside work and unemployment. Doctoral thesis. Stockholm, Karolinska University Press, 2002. [25] Hammarston A., Janlert U., Theorell T.: Youth unemployment and ill health: results from a 2-year follow up study. Soc. Sci. Med. 1988, 26, 102533. [26] Hammer T.: Unemployment and use of drug and alcohol among young people: a longitudinal study in the general population. British Journal of Addiction 1992, 87, 15711581. [27] Lee A.J., Crombie I.K., Smith W.: Alcohol consumption and unemployment among men: the Scottish Heart Health Study. British Journal of Addiction 1990, 85, 11651170. [28] Matoba T., Ishitake, Noguchi.: A 2-year follow-up survey of health and life style in Japanese unemployed persons. Int Arch Occup Environ Health 2003, 76, 302308. [29] Bartley M.: Unemployment and ill health: understanding the relationship. Journal of Epidemiology and Community Health 1994, 48, 333337. [30] Khan S., Murray R.P., Barnes G.E.: A structural equation model of the effect of poverty and unemployment on alcohol abuse. Addict Behav 2002, 27, 40523. [31] Grabauskas V., Klumbiene J., Petkeviciene J.et al.: Health behaviour among Lithuanian adult population, 1994. Helsinki: Publications of the National Public Health Institute, 1995. [32] Grabauskas V., Klumbiene J., Petkeviciene J. et al.: Health behaviour among Lithuanian adult population, 2000. [33] Helsinki: Publications of the National Public Health Institute, 2001. [34] United Nations Development Program. Social Development an Living Environment of Population. Vilnius: UNDP, 1996. [35] Harkin A., Klinkerberg L.: Profiles of Alcohol in the Member States of the European Region of the World Health Organization. Copenhagen: World Health Organization Regional Office for Europe, 1995. [36] Kraut A., Walld R.: Influence of full-time employment on attempted suicide in Manitoba, Canada. Scand. J. Work. Environ. Health. 2003, 29, 1521. [37] Qin P., Agerbo E., Westergard-Nielsen N. et al.: Gender differences ir risk factors for suicide in Denmark. British Journal of Psychiatry 2000, 177, 546550. [38] Jones S., Forster D., Hassanyeh F.: The role of unemployment in parasuide. Psychol Med 1991, 22, 167176. [39] Beautrais A., Joyce P., Mulder R.: Unemployment and serious suicide attempts. Psychol. Med. 1998, 28, 209218. [40] Blakey T.A., Collings S.C.D., Atkinson J.: Unemployment and suicide. Evidence for a causal association? J. Epidemiol. Community. Health. 2003, 57, 594600. [41] Platt S.: Unemployment and suicidal behaviour: a review of the literature, Soc. Sci. Med. 1984, 19, 93115. [42] Weyerer S., Wiedenmann A.: Economic factors and the rate of suicide in Germany between 1881 to 1989, Psychological Report, 1995, 76, 133141. [43] Raskans E., Salander Renberg G., Jacobson L.: Major demographic, social and economic factors associated to suicide rates in Latvia 19801998. Acta Psychiatrica Scandinavica 2001, 103, 275281.
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To cite this article: Kaladiene R., Petrauskiene J., Stankunas M., Association between unemployment and mental health during the period of socio-economic transition in Lithuania, [in:] Niebrσj L., Kosiρska M., Unemployment and Health Care, Katowice: Wyd. SAM 2004, p. 35-42 |
