EVIDENCE BASED PUBLIC HEALTH POLICY AND PRACTICE Work and health in a contemporary society: demands, control, and insecurity

Objective: To examine independent associations of job strain (high demands and low control) and job insecurity with mental and physical health outcomes. Design: Cross sectional general population study conducted in 2000 using a self completed questionnaire. Setting: Two adjoining cities in south east Australia. Subjects: 1188 employed professionals, aged 40–44 years, 55% (n = 655) male. Main outcome measures: Depression, anxiety, physical, and self rated health (SRH). Results: Adverse job conditions were relatively prevalent as 23% of the sample reported high job strain, while 7.3% and 23% reported high and moderate job insecurity respectively. Associations between job conditions and health persisted after adjustment for gender, education, marital status, employment status, major life events, and negative affectivity (personality). When adjusted for job strain, high job insecurity was independently associated with a greater than threefold increase in odds for poor SRH, depression and anxiety (OR (95% confidence intervals) poor SRH: 3.72 (1.97 to 7.04) depression: 3.49 (1.90 to 6.41), anxiety: 3.29 (1.71 to 6.33)), and a twofold increase for physical health 2.19 (1.21 to 3.95). High job strain also showed significant independent associations with depression: 2.54 (1.34 to.4.75) and anxiety: 3.15 (1.48 to 6.70). Conclusion: In this relatively privileged socioeconomic group, insecure employment and high job strain showed independent, consistent, and strong associations with physical and mental health. These adverse job conditions are on the increase, particularly insecure employment, and the influence of these two work conditions are an important focus for future public health research and their prevalence and impact should be examined in other occupations.