Epidemiologists have long recognized that working adults are healthier, on average, than non-working adults, a phenomenon referred to as the “healthy worker effect”. It has not been clear, however, whether the effect was due to detrimental effects of job loss and unemployment (stress hypothesis), a positive effect of employment (causative hypothesis), or a selection effect because unhealthy individuals were less likely to be able to maintain employment (selection hypothesis).
An article in the March, 2012, issue of the American Journal of Public Health provides a systematic literature review of the effects of reemployment on individual health. The authors identified 355 articles for consideration. To be included in the review, eighteen studies met the inclusion criteria: longitudinal studies which covered a transition from unemployed to employed, subjects at least 25 years old (to exclude or minimize those being employed for the first time), both genders included, a measure (either self-report or objective) of how employment affected health (either physical or mental). Cross-sectional studies and studies that did not provide data at the individual level were excluded. The eighteen studies included data from over 2.5 million individuals in seven countries.
The authors found that “Fifteen studies observed a beneficial effect of returning to work on health …. Only 3 studies failed to find a beneficial health effect of returning to work, and none found a harmful effect associated with returning to work.” Furthermore, the authors concluded that four studies support the causative hypothesis that returning to work has a beneficial effect on health, five studies support a predominately causative role with an additional selection role, and two studies found support for only the selection hypothesis. In the discussion, the authors state: “Taken together, these studies suggest that selection and causation mechanisms are mutually reinforcing processes that work synergistically to shape people’s employment and health trajectories over time.”
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