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Engaging in chronically stressful behaviours has been hypothesised to increase the risk of experiencing cardiovascular disease (CVD). Providing unpaid care is known to be a stressful activity, but it is not clear whether this caregiving is associated with CVD. This study filled a gap in the existing literature by examining the association between providing unpaid care and incident cardiovascular disease among a nationally representative sample of Australian adults. 11,123 adult participants aged over 18 years from the Household Income and Labour Dynamics in Australia (HILDA) survey were followed for up to 14 years from baseline (2003) until 2017. Gender-stratified survival analysis models used self-reported caregiving and heart disease statuses as well as time-varying covariates, to assess the association between providing high-intensity or low-intensity unpaid care (to an elderly or disabled relative) and incident CVD in comparison with a non-caregiving control. Among females, there was weak evidence that CVD was associated with high-intensity unpaid care (HR = 1.27, 95% CI = [0.83, 1.95]) and no evidence for low-intensity unpaid care (HR = 0.79, 95% CI = [0.50, 1.26]) in comparison with non-carers after adjusting for confounders. There was no association between caregiving and incident CVD for high-intensity (HR = 0.82, 95% CI = [0.47, 1.42]) or low-intensity (HR = 0.84, 95% CI = [0.55, 1.28]) caregiving males in the adjusted models. These findings do not provide strong evidence to reject the null hypothesis that providing unpaid care does not increase risk of developing CVD in the Australian population. Given that these findings are somewhat inconsistent with the extant literature from other populations, further research is necessary, both in Australia and internationally, to build on the findings of this study and improve understanding of the nature of the association between caregiving and incident CVD.

BackgroundUnderemployment is an increasing feature of global labour markets. However, the mental health impacts of underemployment remain relatively under-researched. Longitudinal evidence is particularly sparse, as is accounting for gender differences in the association. Addressing key gaps, this study examines the association between time-related underemployment and mental health in Australian adults.MethodsPooled panel data from 21 waves (2002–2022) of the Household, Income and Labour Dynamics in Australia survey (n=18 288 participants, 124 531 observations) was used. Fixed-effects linear regression and Mundlak adjustment modelling was conducted to examine how time-related underemployment (not underemployed, underemployed 1–5, 6–10, 11–20 and ≥21 hours) was associated with 5-item mental health scale, with adjustment for time-varying confounders.ResultsA stepwise (or dose-dependent) association was observed between increasing time-related underemployment and mental health for both genders, with the strongest association observed in those underemployed by ≥21 hours for both women (−1.88, 95% CI −3.09 to –0.67) and men (−2.24, 95% CI −3.59 to –0.89). Some gender differences were observed. Most notably, more women in our sample were underemployed compared with men.ConclusionsAddressing rising underemployment in labour markets has the potential to improve population mental health for everyone. Furthermore, targeted social policy to reduce gendered exposure to underemployment in Australia is also key to mental health gains in working-age women.

This study aimed to investigate the effect of precarious employment (PE) on the mental health of Australians. Building on previous research, we conceptualised PE as a multidimensional construct, accounted for gender differences in the associations, and our modelling strategy addressed the possibility of reverse causality bias. Data was pooled panel data from 15 waves (2005–2019) of the HILDA survey ( n  = 14,237). Using PCA, we created two multidimensional measures of PE: objective and subjective. Fixed effects (FE) regression models (attending to unmeasured time-invariant confounders) estimated the change in mental health associated with a change in PE, and instrumental variable (IV) analyses (addressing endogeneity bias) obtained an unbiased estimate of effect of subjective PE on mental health (with ordinary least squares (OLS) models as baseline). For both genders, FE models showed that objective and subjective multidimensional PE both had a strong negative association with mental health (stronger for subjective PE). IV analysis indicated OLS models overestimate the relationship between subjective PE and mental health for men but underestimate it for women, providing causal evidence that subjective PE is important for women’s mental health. Overall, findings suggest that targeted PE policies have the potential to provide significant population mental health gains, particularly for working women.

In many Western countries, including Australia, construction workers have been identified as being at elevated risk of suicide compared to other workers. A variety of suicide prevention initiatives have been implemented and expanded to reduce suicide in this occupational group; however, the net effect of these is unknown. Using 19 years of national suicide data, this study examined the suicide mortality of Australian male construction workers relative to all other working males, and compared suicide rates over time between the two groups. Age-standardized suicide rates were calculated for construction workers and those employed in other occupations. 2001–2019 trends in age-standardized rates of suicide mortality were analyzed by joinpoint regression analysis. The annual average percentage change (AAPC) measure was calculated for both groups to quantify change over time within each group, complemented by a pair-wise AAPC comparison of changes in trends between the two groups over the 2001–2019 period. Australian male construction workers' overall age-standardized suicide rate was 26.6 per 100,000 persons compared to 13.2 per 100,000 for male workers employed in other occupations (pooled over the entire 2001–2019 period). Over time, the suicide mortality rate declined in both construction workers and those working in other occupations; however, the decline in suicide mortality was greater in construction workers (AAPC: −3.0; 95%CI −4.0, −2.0) compared to other workers (AAPC: 1.5; 95%CI −2.1, −1.0). The AAPC pair-wise comparison showed a significant difference between the rate of decline among construction versus other workers over the 19-year study period (AAPC: −1.4; 95%CI 0.4, 2.5), confirming a rapid decline among construction versus other male workers. This study provides evidence of a decline in suicide rates among Australian construction workers over the last two decades. This decline may be attributable to the combined effects of population-wide, male-specific, and sector-specific suicide prevention efforts over this same period, suggesting that the continuation or expansion of such efforts may lead to further declines.

The COVID-19 pandemic imposed additional and specific challenges on the lives and wellbeing of informal unpaid carers. Addressing an important gap in the existing literature, this systematic review (prospectively registered with PROSPERO CRD42022376012 ) synthesises and evaluates the quantitative evidence examining the association between unpaid caregiving and mental health (compared to non-caring), during the pandemic. Five databases were searched (Medline, PsycInfo, EMBASE, Scopus, Web of Science) from Jan 1, 2020, to March 1, 2023. Population-based, peer-reviewed quantitative studies using any observational design were included, with screening, data extraction and quality assessment (amended NOS) independently conducted by two reviewers. Of the 3,073 records screened, 20 eligible studies (113,151 participants) were included. Overall quality of evidence was moderate. Narrative synthesis was complemented by Effect-direction and Albatross plots (given significant between-study heterogeneity precluded meta-analysis). Results indicate that the mental health of informal carers, already poorer pre-COVID compared to non-caregivers, was disproportionally impacted as a result of the pandemic and its associated public health containment measures. This review highlights the vulnerability of this group and should motivate political will and commensurate policies to ensure unpaid caregivers are better supported now, in the medium term, and crucially if, and when, another global public health emergency emerges.

Objectives Psychosocial work stressors are common exposures affecting the working population, and there is good evidence that they have adverse health consequences. There is some evidence that they may impact on mortality, but this has not been systematically examined. We performed a systematic review, including risk of bias, and meta-analyses of observational studies to examine the association between psychosocial work stressors and all-cause mortality and death due to coronary heart disease (CHD). Methods Electronic databases were searched to identify studies and information on study characteristics and outcomes extracted in accordance with PRISMA guidelines. Risk estimates of outcomes associated with psychosocial work stressors: specifically, all-cause mortality, and death due to CHD were pooled using inverse variance weighted random effects meta-analysis. Results We identified 45 eligible cohort studies, of which 32 were included in the quantitative analyses of psychosocial work stressors and mortality. Low job control was associated with an increased risk of all-cause mortality [hazard ratio (HR) 1.21, 95% confidence interval (CI) 1.07-1.37, minimally-adjusted; HR 1.05, 95% CI 1.01-1.10, multivariable-adjusted; HR 1.03, 95% CI 1.00-1.06 exclusion of low quality studies and multivariable-adjusted] and CHD mortality [HR 1.50, 95% CI 1.42-1.58, minimally-adjusted; HR 1.23, 95% CI 1.17-1.30, multivariable-adjusted; HR 1.19, 95% CI 1.01-1.40, exclusion of low quality studies and multivariable-adjusted]. Conclusions Workers with low job control are at increased risk of all-cause and CHD mortality compared to workers with high job control. Policy and practice interventions to improve job control could contribute to reductions in all-cause and CHD mortality.

OBJECTIVES: In Sweden, the number of working-aged women in employment is now almost equal to that of men. While this has many benefits, it presents challenges in organizing work and non-work responsibilities around children, which may impact employees` mental health. METHODS: Based on the Swedish Longitudinal Occupational Survey of Health (SLOSH) cohort study, we prospectively examined gender differences for the effects of work–family conflict and caring for children on mental health among Swedish workers. Mental health status was assessed using a brief (Hopkins) symptom checklist depression scale. We used information from three waves of data over five years (2014–2018) for 5846 women and 4219 men aged 20–64 at baseline. Linear fixed-effects analyses were performed examining within-person changes in work interfering with family (WFC) and family interfering with work (FWC) and associated changes in depressive symptoms by childcare intensity (0, 1–10, >10 hours/week) and sex. RESULTS: Changes in mean scores for WFC and FWC were associated with changes in depressive symptoms for men [no childcaring: WFC 1.31 (95% confidence interval (CI) 1.13–1.49), FWC 0.70 (95% CI 0.43–0.96); childcaring >10 hours/week: WFC 1.39 (95% CI 0.53–2.25), FWC 1.24 (95% CI 0.27–2.21)] and women [no childcaring: WFC 1.57 (95% CI 1.41–1.73), FWC 1.04 (95% CI 0.79–1.30); childcaring >10 hours/week: WFC 2.04 (95% CI 1.36–2.73), FWC 1.57 (95% CI 0.82–2.32)]. CONCLUSION: Higher levels of WFC and FWC are associated with increased depressive symptoms in both men and women. The impact is greater for those with greater childcaring responsibilities intensity.

PurposeThere is some evidence that employed women report more time pressure and work-life penalties than employed men and other women; however little is known about whether this exerts a mental health effect. This analysis examined associations between household labour force arrangements (household-employment configuration) and the mental health of men and women.MethodsSeventeen waves of data from the Household Income and Labour Dynamics Survey (2001–2017) were used. Mental health was measured using the Mental Health Inventory (MHI-5). A six-category measure of household-employment configuration was derived: dual full-time employed, male-breadwinner, female-breadwinner, shared part-time employment (both part-time), male full-time/female part-time (modified male-breadwinner, MMBW), and female full-time/male part-time. Using fixed-effects regression methods, we examined the within-person effects of household-employment configuration on mental health after controlling for time-varying confounders.ResultsFor men, being in the female-breadwinner configuration was associated with poorer mental health compared to being in the MMBW configuration (β-1.98, 95% CI − 3.36, − 0.61). The mental health of women was poorer when in the male-breadwinner configuration, compared to when in the MMBW arrangement (β-0.89, 95% CI − 1.56, − 0.22).ConclusionThese results suggest that the mental health of both men and women is poorer when not in the labour force, either as a man in the female-breadwinner arrangement, or as a woman in the male-breadwinner arrangement. These results are particularly noteworthy for women, because they pertain to a sizeable proportion of the population who are not in paid work, and highlight the need for policy reform to support women’s labour force participation.

Across high-income countries, unemployment rates among workers with disabilities are disproportionately high. The aim of this study was to identify characteristics of employment associated with dropping out of work and assess whether these were different for workers with versus without disabilities. Using a longitudinal panel study of working Australians (2001 to 2015), the current study estimated Kaplan-Meier curves and Cox proportional hazard regression models to identify predictors of leaving employment, including psychosocial job quality, employment arrangement, and occupational skill level. Effect modification by disability status of the relationship between employment-related factors and exit from the labour market were assessed by including interaction terms and assessing model fit with a likelihood ratio test. Models were adjusted for a range of socio-demographic and health related factors. Compared to those without disability, those with disability had a greater risk of leaving employment (HR 1.26, 95% CI 1.18 to 1.35, p<0.001). Other predictors of exit from work included low-skilled occupation (HR 1.18, 95% CI 1.07 to 1.29, p = 0.001), being in a job with low psychosocial job quality (HR 1.11, 95% CI 1.03 to 1.19, p = 0.007), and casual, labour hire or fixed-term contract employment (HR 1.58, 95% CI 1.48 to 1.69, p<0.001). There was no effect modification by disability status. More research is needed to understand the experiences of workers with disabilities who stay in and leave employment.

Precarity in employment is an increasingly concerning global phenomenon. Yet, despite its rising prevalence and the significant impact it has on many people’s lives and health, definitions of precarious employment are varied, and different terms are often used interchangeably. Differences between high-income and low-income and middle-income countries, as well as diverse cross-national labour market structures, further complicate the scholarship. The purpose of this glossary is to provide a point of reference in this complex landscape. Our aim is to synthesise and define key terms pertaining to precarious, non-standard and informal employment in order to guide ongoing application and understanding in this space. In addition, this glossary takes a preliminary step in defining some key and emerging constructs integral or related to understanding precarity in employment in the rapidly growing gig economy.