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It is well documented that the unemployed have more health problems than the employed, and that social support facilitates coping with unemployment. The association of unemployment and social support with health was examined on the basis of representative data derived from a German study.

For this paper, we analyzed data from the GEDA study that were obtained from persons aged 30 to We report the findings on impairment in three distinct areas physical, emotional, and functional and the results of a multivariate statistical analysis. Unemployed persons aged 30 to 59 years suffer physical, emotional, and functional impairment more commonly than employed persons. Men and women with little social support are more likely to be impaired in these three areas whether they are employed or not.

Physicians should be mindful of the deleterious effect of unemployment on health and should encourage unemployed patients to participate in social networks, as the evidence shows that social support can have health benefits.

The health-related consequences of unemployment are a central subject of medical sociology, health psychology and social medicine and are regularly addressed by federal and regional health reporting bodies in Germany. Many studies have shown clearly that unemployed men and women suffer from more health problems and more frequently behave in ways that pose risks to their health than those who are employed 1 — 4.

Unemployed people use health services more often, are more affected by sleep disorders, depression, anxiety disorders, and addictions, and commit suicide more frequently 5 , 6.

Health-related consequences of unemployment manifest as psychosocial health problems due to loss of income, job-related social contact, or social prestige 7 — This article describes the relationship between unemployment; social support; and physical, emotional, and functional complaints in the German population of working age whether employed or unemployed , on the basis of representative data for As yet there are no representative analyses in Germany of the association between unemployment, social support, and health which examine both the probability of impairments of various kinds and their duration.

Numbers were generated at random on the basis of entries in the telephone directory, and telephone numbers not in the directory could also be included in the sample. The reference population included all adults living in private households with landline telephones. The subjects of the survey were divided into a core subject area which remained constant in follow-up inquiries and a flexible subject area which addressed current problems and subjects.

A total of 21 people were surveyed as part of the study. The response rate, i. It can be assumed that individuals of this age have already completed their education and training but have not yet retired e1.

The dependent variables used were three overall indicators of health-related quality of life. The questions had been translated into German. In this study, the number of days respondents had suffered each of these impairments was analyzed. The indicator social support is based on the Oslo Three-Item Social Support Scale, a scale used in Europe to measure perceived social support 18 , Study participants were asked three questions on how many close friends they had, how involved other people were in their lives, and the availability of help from their neighbors.

According to the instructions for using the scale, the replies were used to calculate a cumulative total score 3 to 14 points , which was then allocated to one of the following categories: low 3 to 8 , medium 9 to 11 , high 12 to In subsequent analyses, the authors first provided a descriptive representation of the distribution of the three dependent variables according to sex and next carried out a multivariate analysis of them on the basis of a regression model for count data zero-inflated negative binomial regression The analyses were conducted using the program Stata, version Figure 1 shows the average number of days with physical, emotional, or functional complaints according to age and sex.

The number of days with physical and functional complaints increases with age in both men and women, while there is a smaller increase in emotional complaints. The number of days with impairments is lower in men than in women in all examined age groups. On average, 30 to year-old men had had physical or emotional complaints on 6. The surveyed men and women suffered health-related functional impairments affecting their daily activities on only 2. Figure 2 shows the number of days with complaints according to employment status and sex.

According to this information, the employed are significantly less frequently affected by physical, emotional, or functional complaints than the equivalent groups of unemployed men and women. There are bigger differences between the employed and the unemployed for women than for men.

The information in Figure 3 is additionally differentiated according to the level of social support perceived by study participants in their surroundings. The group with social support shows significantly better results for all three types of impairment than the unemployed or the employed with only low levels of social support.

Employed people with low levels of social support reported an average of 3. The corresponding figures were 6. Physical and emotional complaints were particularly common in unemployed women with low levels of social support 9. Table 2 shows the results of regression analysis for count data zero-inflated negative binomial regression [e2].

The effect of unemployment and social support on the duration of impairments incidence rate ratio, IRR and the probability of their not occurring odds ratio, OR were examined.

Incidence rate ratio IRR : factor by which the number of days with impairments of each type is increased in comparison to the appropriate reference group Ref. The results show that for unemployed men and women the probability of not having suffered any complaints in the last 30 days is low, while it is significantly higher for respondents with social support than for those who perceive that they have little social support.

When unemployed and employed men and women are compared, only differences in functional impairments are statistically significant, while the effect of social support is significant in all cases except for physical complaints in men. The duration of impairments in the last month is correlated with employment status and perceived levels of social support, regardless of their overall probability of occurrence.

In women the correlation between duration of complaints and employment status and social support is significant for all three types of complaint. In men, only the effect of social support on the duration of functional impairments is not statistically significant. The presented results make it clear that in Germany unemployment is associated with worse physical, emotional, and functional health in both men and women.

Unemployed men and women also suffer from their complaints for longer on average than the employed when their age, financial situation, and level of education are controlled for.

When unemployed and employed people can rely on a supportive social network, this is associated with a lower risk and shorter duration of complaints. It has already been documented many times that the health-related consequences of unemployment can be mitigated by social support 13 , These results are in line with the international literature in that they describe a correlation between unemployment, social support, and various aspects of health for Germany too—for the first time on the basis of representative data.

The results also clearly indicate that the correlation with the duration of complaints is stronger than the correlation with the risk of their occurrence.

The limitations of this research are that it uses cross-sectional data which do not allow causal relationships to be inferred. The relationship between unemployment and health is reciprocal: health and health-related behavior may be either the cause or the result of unemployment 23 , The observed correlation between unemployment and health complaints must therefore be partly due to selection of unemployed individuals with health problems.

However, in the GEDA study participants were also asked about their assessment of the reasons and consequences of their unemployment. Further research should also address correlations between the duration of current unemployment, the availability of social support, and the health of those affected, in greater depth. This is not possible on the basis of current GEDA data. Interpretation of the results must also take into account that the health indicators used were self-reported.

Nevertheless, previous cohort studies have successfully identified correlations between unstable employment and physiological parameters such as blood pressure, cholesterol levels, and body mass index e3. In summary, the current findings support the hypothesis that unemployment seems to be associated with various health complaints. It should therefore not be underestimated in medical practice. In view of the repeatedly documented health benefits of social support, doctors should encourage unemployed patients to engage more actively in non-professional networks instead of isolating themselves socially.

However, the stress caused by loss of employment during a recession cannot be resolved by either the treating physicians or the social networks of those affected alone.

Compensatory measures as part of social policy and employment policy must also buffer the effects of unemployment, so as to minimize negative effects on public health Numerous studies in Germany and abroad have shown that unemployment poses a significant risk to health. Unemployed men and women in Germany suffer more frequently and for longer from physical complaints, psychological complaints, and health-related restrictions of their daily activities than those who are employed.

Men and women who receive social support from their partners, relatives, or friends and acquaintances are affected by such complaints less frequently. The positive correlation between social support and health is observed in both employed and unemployed men and women. The correlations indicate that although social support helps people cope better with unemployment, its health-related consequences cannot be completely mitigated.

Conflict of interest statement. The authors declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors. National Center for Biotechnology Information , U. Journal List Dtsch Arztebl Int v. Dtsch Arztebl Int. Published online Jan Lars E Kroll , Dr. Author information Article notes Copyright and License information Disclaimer.

Received Jul 9; Accepted Sep Copyright notice. This article has been cited by other articles in PMC. Abstract Background It is well documented that the unemployed have more health problems than the employed, and that social support facilitates coping with unemployment.

Results Unemployed persons aged 30 to 59 years suffer physical, emotional, and functional impairment more commonly than employed persons.

Conclusion Physicians should be mindful of the deleterious effect of unemployment on health and should encourage unemployed patients to participate in social networks, as the evidence shows that social support can have health benefits.

Open in a separate window. Results Figure 1 shows the average number of days with physical, emotional, or functional complaints according to age and sex. Figure 1. Figure 2. Figure 3. Table 2 Factors affecting the occurrence and frequency of physical, emotional, and functional complaints Cs in the last month, by sex data source: GEDA , age 30 to 59 years.

Discussion The presented results make it clear that in Germany unemployment is associated with worse physical, emotional, and functional health in both men and women. Footnotes Conflict of interest statement The authors declare that no conflict of interest exists according to the guidelines of the International Committee of Medical Journal Editors.

References 1. RKI Arbeitslosigkeit und Gesundheit. Heft Berlin: Robert Koch-Institut; Gesundheitsberichterstattung des Bundes.

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