86 Resultats
Is the worsening of psychosocial exposures at work in Spain between 2005 and 2010 associated with mental health?
M ireiaU tzet1,2, AlbertN avarro1,2, ClaraLlorens3,4, CarlesM untaner5, SalvadorM oncada3
1 Universitat Autònoma de Barcelona (UAB), Biostatistics Unit, Faculty of Medicine, Cerdanyola del Vallès, Barcelona, Spain.
2 GRAAL
3 Union Institute of Work, Environment and Health (ISTAS), Reference Centre on Work Organisation and Health, Barcelona, Spain.
4 Universitat Autònoma de Barcelona (UAB), Department of Sociology, Political Scien-ces and Sociology Faculty, Bellaterra, Barcelona, Spain.
5 Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, Division of Social and Behavioral Health Sciences, University of Toronto, Toronto, Canada.
Corresponding author
Mireia Utzet, Biostatistics Unit, Faculty of Medicine, Campus UAB, 08193 Cerdanyola del Vallès, Barcelona, Spain. Telephone: + 34 93581 3120. Email: mireia.utzet@uab.cat
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Abstract Aim
The aim of the present study is to analyse whether there is any association between expo-sures to Psychological Demands, Control, Social Support and Insecurity, and the mental health of the working population in Spain in 2010, and changes with respect to 2005.
Methods
Two representative samples of the Spanish working population have been compared, one from 2005 (N=5073) the other from 2010 (N = 3544). Prevalence ratios (PR) of poor mental health between the years 2005 and 2010 according to psychosocial exposures, were estimated using Poisson regression models with robust variance. All analyses have been stratified by gender.
Results
The main results reveal, in 2010, a significant association between exposure to high De-mands, low Social Support and high Insecurity over working conditions, and poor mental health of the working population, both men and women, and between exposure to high Insecurity over losing a job and poor mental health in the case of men. In 2005 there was a significant association between exposure to high Demands and low Social Support, and mental health.
Conclusion
This article represents a first approximation to the association between psychosocial risks and mental health in the context of the crisis which began in 2008. The results are relevant and may be related with the socioeconomic context marked by the rise in unemployment (which reached 20% in 2010) and the destruction of jobs which may aggravate the effect of exposure to high Insecurity over working conditions and over losing a job on the mental health among those still in the labour market.
Key words: Psychosocial factors; job strain; social support; insecurity; mental health
88 Resultats
Introdution
In recent decades occupational health research has demonstrated that psychosocial risks in the workplace are risk factors for workers’ physical and mental health, as a result of job characteristics involving psychological processes linked with the social environment in the workplace. Since the conceptualisation of the Karasek Demand-Control Model (Karasek, 1979), much of this research has focused on the effects of job-related Psycho-logical Demands, the effects of Control (autonomy and opportunities for development) and especially the effects of situations of high strain (i.e. the combination of high job demands and few opportunities for decision and control in order to face them) on the mental and physical health of the working population (Landsbergis, Dobson, Koutsouras,
& Schnall, 2013; Niedhammer, Sultan-Taieb, Chastang, Vermeylen, & Parent-Thirion, 2013). In 1990, Johnson and Hall (Johnson & Hall, 1988) added a third dimension to the model, Social Support at work (support from colleagues and supervisors to perform the job well). It is an independent occupational risk factor, but under situations of very high strain, can either increase risk if low (situations of isolation), or to mitigate it, if high.
Control and Social support are psychological resources which permit modification of the effect of Demands at work (Johnson, 1991).
The world of work and working conditions have changed considerably over the last few decades, due to de-regulation of the labour market and the spread of flexibility as a stra-tegy for competitiveness, to business restructuring, and control of manpower. Thus insta-bility of market demand has been transmitted to the work force in the form of increased precariousness in labour relations and working conditions (Cano, 1998). In this context, psychosocial risks such as Demands, Control, and Support continue to play a key ro-le in the psychosocial work environment (Johnson, 2008), but other psychosocial risks have surfaced, such as Insecurity, which can affect the health of the working populati-on. Job insecurity, for which various definitions and approximations have been given in the scientific literature, has risen notably (D’Souza, Strazdins, Lim, Broom, & Rod-gers, 2003), since after all it is essential to capitalism, and has become a characteristic of labour markets everywhere (Ferrie, Weterlund, Virtanen, Vahtera, & Kivimäki, 2008). It has been shown that Insecurity, understood as a psychosocial risk, represents a risk for the physical and mental health of workers exposed to it (Stansfeld & Candy, 2006; Virtanen et al., 2013). Some studies have shown that the effect of exposure to high strain situati-ons may be modified by exposure to situatisituati-ons of high insecurity (Lilley, Lamontagne, &
Firth, 2011; Strazdins, D’Souza, Lim, Broom, & Rodgers, 2004).
For decades, work organisation in Spain has been based on Taylorist principles (Gonzalez Menendez, 2011; Llorens et al., 2010), which has meant that a high proportion of workers are exposed to situations of low Control. This lack of autonomy has combined with expo-sure to low Demands at work (European Foundation for the Improvement of Living and Working European Foundation for the Improvement of Living and Working Conditions, 2007). However, transformations in the European labour market tending towards an in-tensification of work (European Foundation for the Improvement of Living and Working Conditions, 2007, 2012; NORA, 2002), and the economic crisis which began in 2008, appear to have had an impact on these exposures, particularly Pace of work. The
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se in Psychological Demands, intensification of work and stagnation of Control among workers in Spain has been reported in previous articles (Utzet et al., 2014). On the other hand, some studies have shown that Job Insecurity is high in Spain (Moncada et al., 2010;
Nubling, Vomstein, Haug, Nubling, & Adiwidjaja, 2011). It has also been observed that in a context such as the present, with high unemployment and job destruction, among those workers who have not lost their jobs Insecurity over losing valued working conditi-ons (such as work schedules, salary levels and tasks) has apparently become subordinated to Insecurity about losing the job (Di Nunzio, Hohnen, Hasle, Torvatn, & Oyum, 2009;
Moncada et al., 2014; Utzet et al., 2014).
Common mental disorders such as anxiety and depression are prevalent among workers (Virtanen et al., 2008; Wang, Schmitz, Dewa, & Stansfeld, 2009) and a cause of absente-eism (Roelen et al., 2009; Stansfeld, Shipley, Head, & Fuhrer, 2012). The 2010 European survey of working conditions (European Foundation for the Improvement of Living and Working Conditions, 2012), also analyses mental health, and Spain is found to be one of the countries with small proportions of workers with poor mental health.
Various epidemiological studies have shown that exposure to high Psychological De-mands is associated with common mental conditions (Kivimäki et al., 2010; Netterstrøm et al., 2008), exposure to high Social support with lower risk of suffering depression (Net-terstrøm et al., 2008), exposure to high Control with lower risk of long term sick leave due to mental problems (Janssens et al., 2014) and that exposure to situations of high job strain is associated with, among other things, a worsening of mental health (Muntaner, Anthony, Crum, & Eaton, 1995; Muntaner, Tien, Eaton, & Garrison, 1991; Niedhammer et al., 2013; Theorell et al., 2013). It has also been shown that exposure to high levels of Job Insecurity is associated with greater risk of suffering common mental conditions (Burgard, Brand, & House, 2009; D’Souza et al., 2003; Ferrie et al., 2008; Lilley et al., 2011), although research into this psychosocial dimension is still scarce. The psycho-logical mechanisms that explain these associations, which affect a series of biopsycho-logical variables (Brunner, 1997), may find expression as either emotional responses (anxiety, tension, etc), behaviours (lack of concentration, consumption of drugs, etc), physiologi-cal responses produced by degradation of self-esteem and control at work resulting from exposure to situations of high strain (Mezuk, Bohnert, Ratliff, & Zivin, 2011; Stansfeld &
Candy, 2006), or the ambiguity and lack of control over the future which may result from exposure to high levels of Insecurity (Burgard et al., 2009; Seligman, 1975). There are studies which throw doubt on the causality of the association between poor mental health and exposure to situations of high job strain (Bonde, 2008) and exposure to situations of low social support (Netterstrøm et al., 2008), whereas others have found a non-significant association between Job Insecurity and poor mental health in Spain (Laszlo et al., 2010).
The social and economic crisis which began in 2008 could have had an impact on the mental health of the working population (CSDH, 2008; Ragnarsdottir, Bernburg, & Olafs-dottir, 2012). On one hand, there has been a rise in unemployment, from 9.2% in 2005 to 20.1% in 2010, which could have had a direct effect on the health of the unemployed (Bambra, 2011; Dooley, Fielding, & Levi, 1996). On the other, this context of generalised unemployment and destruction of jobs may also affect the mental health of the working
90 Resultats
population. Specifically, it has been observed that workers surviving staff cuts have a higher risk of suffering physical and mental health problems (Ferrie et al., 2008) and it has been shown that workers exposed to noxious psychosocial risks have a similar or hig-her risk of suffering mental health conditions as unemployed persons (Butterworth et al., 2011; Butterworth, Leach, McManus, & Stansfeld, 2013). Several studies have reported a worsening of mental health in the population following onset of the crisis in 2008, in so-me cases due to worsening among the unemployed population (Borrell, Rodríguez-Sanz, Bartoll, Malmusi, & Novoa, 2014; Chang, Stuckler, Yip, & Gunnell, 2013; Gili, Roca, Basu, McKee, & Stuckler, 2013), but in others among the working population (Katikired-di, Niedzwiedz, & Popham, 2012).
The scientific evidence on the association between situations of high Demands, low Con-trol, low Social Support, and high Insecurity and the deterioration of workers’ mental health, among other illnesses, means that interventions to reduce these situations would have beneficial effects from a public health perspective (LaMontagne, 2012; Stansfeld &
Candy, 2006). In Spain the availability of Psychosocial Risks Surveys (Moncada et al., 2014; Moncada, Llorens, Font, Galtés, & Navarro, 2008) represents an excellent oppor-tunity to obtain privileged information permitting an analysis of the impact and evolution of exposure to demands, control and social support on workers’ mental health during the period from 2005 to 2010, and hence of the possible impact of the economic crisis which began in 2008 on workplace psychosocial environments, and in this way contribute to orient preventive policies.
The aim of the present study is to analyse whether there is any association between expo-sures to Psychological Demands, Control, Social Support and Insecurity, and the mental health of the working population in Spain in 2010 and changes with respect to 2005.
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Materials and methods
Two representative samples of the Spanish working population have been compared, cor-responding to the years 2005 and 2010. In both cases the inclusion criteria were: persons aged between 16 and 65 years, residents in Spain, who had performed paid work for at least one hour during the week prior to the interview. In 2005 a total of 7650 interviews were conducted, with a response rate before substitutions of 60%, while in 2010 there were 5110 interviews and the response rate before substitutions was 56%. The sample design applied in 2005, and also considered applicable in 2010, has been described el-sewhere (Moncada et al., 2014, 2008; Utzet et al., 2014). In the present study we only include workers who had been working in the same organisation for at least two years, in order to ensure sufficient exposure to working conditions (Stansfeld & Candy, 2006), and in consequence the sample sizes are reduced by a third (2005: n=5073; 2010: n=3544).
Table 1 presents the main characteristics of the samples studied. The principal differences, compared to the complete samples (characteristics of which have been reported elsewhere (Moncada et al., 2014, 2008; Utzet et al., 2014)) are that the percentage of people aged under 30 years falls (in 2005 the percentage of workers aged under 24 was 12.4% (11.6;
13.1), the percentage between 25 and 29 years was 17.5% (16.7 ; 18.4); the corresponding figures for 2010 being 6.8% (6.1 ; 7.5) and 13.9% (12.9 ; 14.8) respectively), while the percentage aged over 40 years rises (in 2005 those aged from 40 to 49 being 24.5% (23.5
; 25.5), the percentage between 50 and 59 was 11.8% (11.1 ; 12.6); the corresponding figures for 2010 being 27.9% (26.7 ; 29.2) and 19% (17.9 ; 20.0) respectively; differences were significant in both years.
Table 1. 2010 and 2005 [95% CI= 95% confidence interval].
2005 2010
II: High level professionals 5.5 (4.7 ; 6.2) 3.5 (2.7 ; 4.2) III: Low level professionals 12.3 (11.3 ; 13.4) 14.7 (13.2 ; 16.2) IV: Supervisors 2.5 (2.1 ; 2.9) 3.4 (2.7 ; 4.0) V: Skilled manual workers 32.9 (31.5 ; 34.2) 33.3 (31.6 ; 35.1) VI: Semi-skilled manual workers 24.1 (22.8 ; 25.4) 24.3 (22.8 ; 25.8) VII: Unskilled manual workers 20.3.8 (19.0 ; 21.6) 18.6 (17.1 ; 20.1)
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Measures and variables
The data were obtained from two surveys of psychosocial risks in the workplace, con-ducted in 2005 and in 2010, in which two versions of the previously validated COPSOQ-ISTAS21 instrument were employed (Moncada et al., 2014, 2008; Utzet et al., 2014). The dimensions Psychological Demands, Control, and Support have been measured using tho-se parts of the scales of Demands, Control and Support which were common to the two versions of COPSOQ, as has been done in other studies (Burr, Albertsen, Rugulies, &
Hannerz, 2010). Job Insecurity has been measured based on three dimensions, Insecu-rity about losing a job, InsecuInsecu-rity about finding a job, and InsecuInsecu-rity about losing valu-ed working conditions (changes affecting working hours, tasks and salary) (Utzet et al., 2014). The scores obtained from the 6 scales were dichotomised at cut-points correspon-ding to medians for 2005. A worker presenting a score above the cut-points of all scales would be defined as exposed to high demands, high control, high social support and high insecurity (all three dimensions). Scoring for workers in 2010 is defined using the same cut-points as in 2005, which allows us to identify whether exposure of the group increases or decreases.
Workers’ mental health was assessed based on the mental health scale of the Spanish version of the SF-36 (Alonso, Prieto, & Anto, 1995; Vilagut et al., 2005), a generic ins-trument for assessing self-perceived health status. The mental health scale consists of 5 items which evaluate positive and negative aspects of health, with higher scores represen-ting better health. Calculation of the global dimension score is easy, and is explained in the literature (Vilagut et al., 2005). One simply sums the items of the scale and standar-dises the total to lie between 0 and 100, with 0 representing the worst, and 100 the best mental health.
Many studies give cut-points for mental health problems based on the SF-36 mental health scale, which vary between 42 and 76. Although no particular cut-point has been validated (Kelly, Dunstan, Lloyd, & Fone, 2008), the recommendation is to use reference values for the general population. In this case we have applied the normative values for a repre-sentative sample of the Spanish population (Alonso et al., 1998), as some other similar studies have done (Vives et al., 2011) such that an individual is considered to have poor mental health if their SF-36 score is below the 25th percentile of the normative values for their age and sex. The cut-points vary between 52 and 63.2 for women and between 64 and 68 for men. All these values are lower than 76, the score considered to identify cases of common mental conditions, and which has been used in other studies (Font, Moncada,
& Benavides, 2011; Kelly et al., 2008).
The sociodemographic variables included in the analysis are age and sex. Job category was obtained from the 1994 National Classification of Occupations, which is based on the International Standard Classification of Occupations (ISCO88), and has been reclassified considering people’s management requirements together with job content qualification, criteria which are mixed under the ISCO classification (final groups were: managers, high level professionals, low level professionals, supervisors, skilled, semi-skilled, and unskilled).
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Statistical analysis
Prevalence (and 95%CI) of poor mental health has been calculated for the 2010 sample, and prevalence differences with respect to 2005 data, stratifying by job category and by age.
Prevalence of poor mental health according to psychosocial exposures in 2010 and dif-ferences with respect to 2005 have been calculated. Prevalence ratios (PR), and their corresponding 95%CI, between poor mental health and the psychosocial exposures have been estimated using Poisson regression with robust variance (Barros & Hirakata, 2003;
Zou, 2004) for the years 2010 and 2005. Two approaches have been used, one fitting crude models for each one of the dimensions, the other fitting a model including all dimensi-ons. Finally, we checked the significance of bivariate interactions between the dimensions Demands, Control, Support and Insecurity.
All analyses were stratified by gender, given the differences between men and women in regard to mental health (Klose & Jacobi, 2004; Piccinelli, 2000) and in the exposure to, and effect of, psychosocial risks (Artazcoz, Escribà-Agüirc, & Cortèsa, 2004). All analy-ses have been done using data weighted according to the age and occupation structure, corresponding to the last quarter of 2010 of the Survey of the Economically Active Popu-lation, in order to eliminate possible effects due to the sociodemographic structure, and to make the samples comparable.
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Results
The prevalence of exposure to situations of high Demands, low Control, low Social Sup-port, high Insecurity about working conditions, high Insecurity about losing the job and high Insecurity about finding a job are presented in table 2.
Table 2. Prevalence and 95%CI of exposure to high demands, low control, low social support, high insecurity over working conditions, over losing the job and over finding a job, in 2005 and 2010, by gender [95% CI= 95% con-fidence interval]
2005 2010
Men Women Men Women
% 95% CI % 95% CI % 95% CI % 95% CI
Exigències altes 49.3 (47.2 ; 51.3) 45.8 (43.5 ; 48.1) 51.6 (49.3 ; 54.0) 49.0 (46.1 ; 51.9) Control baix 46.8 (44.7 ; 48.9) 54.5 (52.2 ; 56.8) 50.7 (48.3 ; 53.0) 55.2 (52.6 ; 57.9) Suport social baix 49.8 (47.8 ; 51.9) 51.1 (48.8 ; 53.5) 62.3 (59.9 ; 64.6) 60.4 (57.6 ; 63.3) Inseguretat sobre les
con-dicions alta
49.6 (47.5 ; 51.6) 48.9 (46.6 ; 51.3) 27.9 (25.8 ; 30.0) 29.3 (26.8 ; 31.8) Inseguretat perdre
ocupa-ció alta
56.7 (54.6 ; 58.8) 56.3 (54.0 ; 58.7) 39.5 (37.1 ; 41.8) 40.4 (37.7 ; 43.0) Inseguretat trobar
ocupa-ció alta
57.4 (55.4 ; 59.5) 58.5 (56.2 ; 60.8) 65.1 (62.8 ; 67.4) 67.6 (65.1 ; 70.1)
The proportion of workers with poor mental health in 2010 had not raised compared to 2005 (see table 3). In 2010 men present a prevalence of 35.8%, and women 27.6%. This prevalence increases with age in the case of men (except those aged between 60 and 65 years), whereas among women it tends to decrease. There are no differences in prevalence in terms of job category in either men or women. Female manual or execution workers have lower prevalence of poor mental health than the men in these occupations.
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Table 3. Prevalence and 95%CI of poor mental health in 2010 and differences with respect to 2005. Overall and by gender, age and job category.
2010 2010 - 2005
Men Women Men Women
Prevalence 95% CI Prevalence 95% CI Prevalence difference
95% CI Prevalence difference
95% CI
Total 35.8 (33.5 ; 38.1) 27.6 (25.2;30.0) 0.2 (-2.6 ; 3.0) 1.6 (-1.3; 4.5)
16 - 24 16.0 ( 5.8 ; 26.1) 33.5 (16.9;50.1) -14.1 (-30.7; 2.41) 11.8 (-5.4; 29.0)
25 - 29 33.6 (26.7 ; 40.5) 29.7 (21.4 ; 38.0) 1.1 (-8.7;10.9) 2.7 (-7.2;12.6)
30 - 39 35.9 (31.6 ; 40.1) 30.3 (25.6 ; 35.0) 3.8 (-1.1; 8.9) 5.9 (0.5 ;11.3)
40 - 49 39.9 (35.7 ; 44.2) 26.4 (22.5 ; 30.3) 1.0 (-4.0; 6.2) -1.1 (-6.3; 4.26)
50 - 59 37.2 (32.4 ; 42.0) 24.8 (19.8 ; 29.8) -1.9 (-8.0; 4.2) -2.5 (-8.9; 3.8)
60 - 65 18.3 (11.0 ; 25.7) 21.8 (11.4 ; 32.1) -11.5 (-23.2;0.1) 3.5 (-9.8;16.7)
I: Managers 53.3 (35.7 ; 71.5) 41.7 (1.8 ; 81.5) 18.6 (0.4 ; 33.2) 15.0 (-16.1; 46.0))
II: High level professionals 33.2 (20.1; 46.3) 17.9 (5.8 ; 30.1) -2.3 (-15.8;11.1) -9.6 (-23.4; 4.1) III: Low level professionals 26.2 (20.1 ; 32.2) 23.0 (17.0 ; 29.1) -5.5 (-13.4; 2.2) 2.8 (-4.0 ; 9.7) IV: Supervisors 44.3 (33.6 ; 55.0) 46.7 (28.9 ; 64.6) 19.6 (5.2 ; 33.9) 18.1 (-10.4 ; 46.6) V: Skilled manual workers 37.2 (33.9 ; 40.5) 25.7 (20.8 ; 30.5) 2.7 (-1.5; 7.0) 5.2 (-1.0;11.3) VI: Semi-skilled manual workers 34.0 (29.2 ; 38.9) 27.9 (24.0 ; 31.8) 0.5 (-7.2 ; 6.3) 1.1 (-4.4 ; 6.6) VII: Unskilled manual workers 35.7 (30.2 ; 41.2) 30.9 (25.7 ; 36.1) -10.8 (-18.6;-3.0) -6.3 (-12.1;-0.5)
96 Resultats
As may be observed in table 4, for 2010 the prevalence of poor mental health is signi-ficantly higher for exposure to high Demands, low Control, low Support and high Inse-curity, as well as for men with respect to women. However, the difference in prevalence of poor mental health with respect to 2005 is only significant for Insecurity over working conditions and Insecurity over losing a job, prevalence rising in both cases.
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Table 4. Prevalence and 95%CI of poor mental health according to psychosocial exposures in 2010, and differences with respect to 2005, by gender.
2010 2010 - 2005
Men Women Men Women
Prevalence 95% CI Prevalence 95% CI Prevalence difference
95% CI Prevalence difference
95% CI Demands
Low 22.1 (19.3 ; 24.9) 19.7 (16.7 ; 22.8) -0.8 (-4.3 ; 2.7) 2.2 (-1.4 ; 5.8)
High 48.5 (45.2 ; 51.9) 35.6 (31.9 ; 39.3) -0.3 (-4.4 ; 3.8) -0.4 (-4.9 ; 4.2)
Control
Low 39.7 (36.5 ; 42.9) 28.9 (25.6 ; 32.2) 0.9 (-3.2; 4.9) 0.6 (-3.4 ; 4.6)
High 31.5 (28.3 ; 34.8) 25.8 (22.2 ; 29.3) -1.3 (-5.2 ; 2.5) 2.7 (-1.6 ; 6.8)
Social Support
Low 43.5 (40.4 ; 46.6) 33.4 (29.9 ; 36.9) -2.0 (5.9 ; 2.0) -0.1 (-4.4 ; 4.2)
High 25.0 (21.6 ; 28.5) 20.9 (17.1 ; 24.6) -0.3 (-4.4 ; 3.7) 2.7 (-1.6 ; 7.0)
Insecurity over working conditions
Low 29.6 (27.1 ; 32.2) 22.1 (19.5 ; 24.7) -5.9 (-9.3; -2.4) -5.3 (-8.9; -1.8)
High 51.6 (47.2 ; 56.1) 40.7 (35.6 ; 45.7) 16.1 (11.1 ; 21.0) 16.2 (10.9 ; 21.6)
Insecurity about finding a job
Low 27.7 (24.0 ; 31.3) 20.4 (16.7 ; 24.1) -8.0 (-12.4;-3.7) -5.3 (-9.9 ;-0.7)
High 40.2 (37.3 ; 43.0) 31.0 (28.0 ; 34.1) 4.5 (1.1 ; 8.3) 4.8 (1.1 ; 8.5)
Insecurity about losing a job)
Low 28.3 (25.5 ; 31.1) 22.6 (19.7 ; 25.5) -7.1 (-10.9;-3.4) -3.5 (-7.4 ; 0.3)
High 47.4 (43.7 ; 51.1) 35.0 (30.9 ; 39.1) 11.7 (7.4 ; 15.9) 9.1 (4.5 ; 13.6)
98 Resultats
As table 5 shows, for 2010, in the unadjusted models all dimensions present significant associations with poor mental health in the expected direction. When a single model is fitted the associations persist for the dimensions Demands, Social Support and Insecurity over working conditions in both men and women, and for Insecurity over losing a job among men. For 2005 there are only associations with the dimensions Demands and Social Support. We calculated the interactions between Demands and each of the other dimensions (data not shown). The only significant interaction was with Social Support, i.e. there is a significant association between exposure to low Demands and poor mental
As table 5 shows, for 2010, in the unadjusted models all dimensions present significant associations with poor mental health in the expected direction. When a single model is fitted the associations persist for the dimensions Demands, Social Support and Insecurity over working conditions in both men and women, and for Insecurity over losing a job among men. For 2005 there are only associations with the dimensions Demands and Social Support. We calculated the interactions between Demands and each of the other dimensions (data not shown). The only significant interaction was with Social Support, i.e. there is a significant association between exposure to low Demands and poor mental