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  • 1.
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för hälsovetenskap.
    Employment Status and Inequalities in Health Outcomes: Population-based Studies from Gävleborg County2017Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background and objectives: From a public health perspective, it is important not only to improve and maintain health, but also to promote equality in health. Epidemiological research has showed the importance of work and unemployment in the development of socio-economic health inequalities, and peoples life chances are suggested to be conditioned by participation or exclusion from the labour market. The most recent economic recession has brought further changes to the labour market that might have aggravated the already multifaceted image of inequalities in health. Gävleborg County was one of the hardest hit counties in Sweden, which experienced a myriad of changes in the labour market that went beyond those of the Swedish national average, in terms of increase in flexible forms of employment, factory closures, and lay-offs. The overall objective of this thesis was to investigate the relationship between employment status and health-related inequalities in Gävleborg County, Sweden. In addition, the Specific objectives for the thesis were to: assess the relationship between employment status and self-reported health in Gävleborg (Study I); to estimate the relationship between employment status and suicidal ideation during the economic recession in Gävleborg (Study II); to estimate the prevalence of anxiety and depression among economically active people living in the Municipality of Gävle (Study III) and to assess experiences and perceptions of well-being after involuntary job loss in Gävle (Study IV).

    Methods: Study I and II in this thesis used data from the 2010 Health in Equal Terms survey, a cross-sectional survey carried out in Gävleborg County in Sweden. A total of 4,245 individuals, aged 16–65 years were included in the analyses. Study III was performed in Wave 1 (baseline survey) of the Gävle Household, Labour Market Dynamics and Health Outcomes survey (GHOLDH), a panel survey with household as the follow-up unit. A total of 241 persons completed a self-administered postal questionnaire which collected information on the employment status and psychological health (anxiety and depression) among persons aged 18–65 years. The thesis used descriptive analyses and logistic regression models to describe and explore the relationship between employment status, self-reported health and suicidal ideation in Gävleborg County (Studies I and II). Descriptive analysis of means and a multiple regression analysis for adjusted means of HADS, were used in order to estimate the prevalence of anxiety and depression among economically active persons residing in the Gävle Municipality (Study III). Study IV used a qualitative approach to gain a deeper understanding of how involuntarily unemployed persons in Gävlexperceive their well-being. Sixteen unemployed men and women aged 28–62 were interviewed face-to-face. A purposeful sampling strategy was used in order to suit the research question and to increase the variation among informants. The interview texts in Study IV were analysed using thematic analysis.

    Results: In Study I, the prevalence of poor self-reported health (SRH) was twice as high in the group of people who were not employed (42%) compared to the employed group (21.6%). Individuals outside the labour market had odds of poor health of 2.64 (Cl 2.28–3.05) compared to their employed counterparts. Controlling for other covariates reduced the risk slightly to 2.10 (1.69–2.60), but remained statistically significant. Moreover, other variables such as long-standing illness, age, income and lack of social support were associated with self-reported poor health. In Study II, among those not employed, 11.2% had been in a situation where they had seriously considered taking their life (at some time during the past 12 months). The corresponding figure for those employed was 2.9%. Unadjusted results of the logistic regression analysis revealed that people who were not employed had about a four times higher risk of suicidal ideation, with an OR of 4.21 (CI: 3.14–5.64) compared to their employed counterparts. Controlling for other covariates, reduced the risk from 4.21(CI 3.14–5.64) in model I, to 1.73 (CI 1.16–2.57) in model IV, but remained statistically significant. In addition, other variables were associated with suicidal ideation. In Study III, the prevalence and risk of anxiety and depression were high among people who were out of work. In the multiple regression analysis, compared to employed people, those who were not employed had a risk of anxiety of 7.76 (5.97–9.75) and 4.67 (3.60–5.74) for depression. Study IV revealed six different themes from the interviews: Work was perceived as the basis for belonging; loss of work affected people’s social life and consumption patterns due to changes in their financial situation. Feelings of isolation, loss of self-esteem, and feelings of hopelessness were reported, affecting the respondents’ physical well-being. Longer duration of unemployment increased the respondents’ negative emotions. Activities, structure, and affiliation in other contexts were reported as part of their strategy for coping with poor mental health.

    Conclusion: This thesis found a statistically significant relationship between being outside the labour market and poor SRH, a high risk of suicidal ideation, anxiety, and depression during the recent economic recession. The relationship between employment status and SRH was partially explained by socioeconomic, demographic and lifestyle variables. In addition, the relationship between employment status and suicidal ideation was, for the most part, explained by demographic, socio-economic and self-reported psychological variables. Atxithe municipal level, the prevalence of anxiety and depression was higher among those who were out of the labour market as compared to those who were employed and the odds of anxiety and depression were higher among people out of the labour market, but this was less prominent for depression than for anxiety. Job loss created feelings of loss of dignity and belonging as a human being. The participants experienced feelings of worry, insecurity, and stress due to their changed financial situation, which in turn led to isolation and loss of self-esteem. Social support and having activities other than work gave structure and meaning to everyday life. The results of this thesis indicate a need for early detection and potential treatment of people out of the labour force and for being aware of the increased risk of poor health symptoms and disorders among unemployed individuals. The findings also indicate a need for primary prevention strategies, implying that policy-makers must pay attention to the health status of those who are out of work, especially during times of combined economic hardship and labour market fluctuations. However, longitudinal studies are warranted to shed further light on the mechanisms through which employment status and conditions impact physical and psychological health outcomes.

  • 2.
    Hiswåls, Anne-Sofie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Avdelningen för hälsovetenskap.
    Ghilagaber, Gebrenegus
    Avdelningen för statistikvetenskap, Stockholms Universitet, Department of Statistics, University of Stockholm.
    Walander, Anders
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Center for Epidemiology and Community Medicine, Stockholm County Council, Stockholm Sweden.
    Wijk, Katarina
    Samhällsmedicin, Landstinget Gävleborg, Community Medicine, County Council of Gävleborg.
    Öberg, Peter
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Soares, Joaquim
    Mittuniversitetet, Avdelningen för hälsovetenskap, Mid Sweden University, Department of Health Science.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Avdelningen för hälsovetenskap.
    Employment Status and Inequalities in Self-Reported Health2014In: Epidemiology, Biostatistics and Public Health, ISSN 2282-2305, E-ISSN 2282-0930, Vol. 11, no 4, p. 1-11Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to investigate the impact of employment status on self-reported health in gävleborg county.

    Methods: The study used data from the 2010 health in equal terms survey, a cross-sectional survey carried out in gävleborg county in sweden. a total of 4,245 individuals, aged 16–65 years were included in the analyses. descriptive and logistic regression analyses were used to assess the relationship between employment status and self-reported health

    Results: Individuals outside the labour market had odds of poor health of 2.64 (cl 2.28–3.05) compared to their employed counterparts. controlling for other covariates reduced the risk slightly to 2.10 (1.69-2.60), but remained statistically significant. In addition, other variables were associated with self-reported poor health.

    Conclusions: This study found a statistically significant association between being outside the labour market and poor self-reported health. The relation was explained partially by socio-economic and demographic variables. More studies, in particular longitudinal, are needed to further investigate the observed relationships. Policy-makers within the gävleborg county need to pay attention to the health status of those out of work, especially during times of combined economic and labour market fluctuations.

    Results of the study suggest the need to pay attention to the health status of those outside the labour market, especially during times of economic hardship.

  • 3.
    Hiswåls, Anne-Sofie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Avdelningen för hälsovetenskap.
    Ghilagaber, Gebrenegus
    Stockholms universitet, Statistiska institutionen.
    Wijk, Katarina
    Öberg, Peter
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Soares, Joaquim
    Mittuniversitetet, Fakulteten för humanvetenskap, Avdelningen för omvårdnad.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Institutionen för hälsovetenskap; Karolinska Institutet.
    Employment status and suicidal ideation during economic recession2015In: Health Science Journal, ISSN 1791-809X, Vol. 9, no 1, article id 13Article in journal (Refereed)
    Abstract [en]

    Objective: Suicide is a public health problem and an important indicator of severe mental ill-health. Thus, identifying risk factors for suicidal ideation is a public health priority. The aim of this study was to examine the relationship between employment status and suicidal ideation in Gävleborg County. Method: The study used data from the 2010 Health in Equal Terms survey, a cross-sectional survey carried out in Gävleborg County in Sweden. A total of 4,245 individuals, aged 16–65 years were included in the analyses. Descriptive and logistic regression analyses were carried out to assess the relationship between employment status and suicidal ideation Results: Individuals outside the labour market had odds of suicidal ideation of 4.21 (CI 3.14-5.64) compared to their employed counterparts. Controlling for other covariates, reduced the risk from 4.21(CI 3.14-5.64) in model I, to 1.73 (CI 1.16- 2.57) in model IV, but remained statistically significant. In addition, other variables were associated with suicidal ideation. Conclusion: There was a statistically significant association between being out of work and suicidal ideation. The association was explained partly by demographic, socio-economic and self-reported psychological variables. Results of the study suggest the need for primary prevention strategies among those out of the labour market, especially during times of economic hardship.

  • 4.
    Hiswåls, Anne-Sofie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Avdelningen för hälsovetenskap.
    Ghilagaber, Gebrenegus
    Avdelningen för statistik, Stockholms universitet, Department of statistics, Stockholm University.
    Wijk, Katarina
    Samhällsmedicin, Landstinget Gävleborg, Community Medicine,Gävleborg County Council .
    Öberg, Peter
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Soares, Joaquim
    Mittuniversitetet, Avdelningen för hälsovetenskap, Mid Sweden University, Department of Health Science .
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Mittuniversitetet, Avdelningen för hälsovetenskap, Mid Sweden University, Department of Health Science .
    Inequalities and Suicide Ideation during Recession Times2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no Suppl. 2, p. 361-Article in journal (Other academic)
    Abstract [en]

    Background

    Suicide behaviour is a serious public health problem as it imposes economic and human costs to individuals, families and communities. Available evidence from some European countries indicates a significant rise in suicides related to economic recession. However, the debate continues regarding the role of unemployment in the reported suicide rates. In Sweden, very few studies have investigated the relationship between suicide behaviours and employment status in the context of the recent economic crisis although unemployment increased nationally and across different counties.

    The aim of this study was to examine the relationship between employment status and suicide ideation in Gävleborg, Sweden.

    Methods

    The study used data from a cross-sectional survey, Health in Equal terms, carried out in Gävleborg County in Sweden, 2010. A total of 4245 individuals, aged 16–65 years were included in the analysis. The relationship between employment status and suicide ideation was assessed using descriptive and logistic regression analyses.

    Results

    People who were not working had odds of suicide ideation of 4.21 (95% Cl 3.14–5.64) as compared to those employed. Controlling for other covariates reduced the risk to 1.73 (95% CI 1.16-2.57) but remained statistically significant. In addition variables like anxiety, self-reported stress and young age were also associated with suicide ideation. However among the covariates, people who reported anxiety had the highest odds of suicide ideation.

    Conclusions

    This study found a statistically significant association between being out of work and suicide ideation. The association was largely explained by self-reported stress, anxiety, socioeconomic and demographic variables.

    Policy-makers within the County need to pay attention to the health status of those out of work, especially during times of combined economic and labour market fluctuations.

    Key messages

    • Suicide ideation was more common among people out of labor force in Gävleborg County, Sweden.

    • Further studies are needed to investigate suicide ideation among unemployed persons during times of economic and labor market insecurity.

  • 5.
    Hiswåls, Anne-Sofie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Section of Public Health Sciences, Mid-Sweden University, Sweden.
    Marttila, Anneli
    Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
    Mälstam, Emelie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Sciences, Section of Public Health Sciences, Mid-Sweden University, Sweden; Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Epidemiology Unit-ISPUP, University of Porto Medical School, Portugal.
    Experiences of Unemployment  and Well-Being  After Job Loss During Economic Recession: Results of a Qualitative Study in East Central Sweden2017In: Journal of Public Health Research, ISSN 2279-9028, E-ISSN 2279-9036, Vol. 6, no 3, p. 135-141, article id 995Article in journal (Refereed)
    Abstract [en]

    Introduction: Several studies have revealed an association between unemployment and ill health, and shown that unemployment can affect people differently. This study aimed to provide an understanding of the experiences of unemployment and perceptions of wellbeing among persons who involuntary lost their work during the recent economic recession in Gävle Municipality. Methods: Sixteen unemployed men and women aged 28-62 were interviewed face-to-face. A purposeful sampling strategy was used in order to suit the research question and to increase the variation among informants. The interview texts were analysed using thematic analysis. Results: Six different themes emerged from the accounts: The respondents perceived work as the basis for belonging, and loss of work affected their social life and consumption patterns due to changes in their financial situation. They also expressed feelings of isolation, loss of self-esteem, and feelings of hopelessness, which affected their physical well-being. Longer duration of unemployment increased the respondents’ negative emotions. The respondents reported activities, structure, and affiliation in other contexts as part of their coping strategy against poor mental health. Conclusions: After job loss, the respondents experienced feelings of loss of dignity and belonging as a human being. They also felt worry, insecurity, and stress due to their changed financial situation, which in turn led to isolation and loss of self-esteem. Social support and having other activities gave the respondents structure and meaning.

  • 6.
    Hiswåls, Anne-Sofie
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of health sciences, Mid-Sweden University, Sweden.
    Walander, Anders
    Department of health sciences, Mid-Sweden University, Sweden; Department of public health, Karolinska institute, Stockholm, Sweden.
    Soares, Joaquim F J
    Department of health sciences, Mid-Sweden University, Sweden.
    Macassa, Gloria
    University of Gävle, Faculty of Health and Occupational Studies, Department of Health and Caring Sciences, Caring science. Department of health sciences, Mid-Sweden University, Sweden; Department of public health, Karolinska institute, Stockholm, Sweden.
    Employment Status, Anxiety and Depression in a Municipal Context2017In: Research in Health Science, ISSN 2470-6213, Vol. 2, no 1, p. 12-23Article in journal (Refereed)
    Abstract [en]

    Objectives:This study aimed to investigate the prevalence of anxiety and depression by employment status among a sample of the working age population residing in Gävle Municipality in Sweden.

    Methods: A total of 241 persons completed a self-administered postal questionnaire in the baseline survey of the Gävle Household, Labour Market and Health Outcomes (GHOLDH) survey, which collected information on the employment status and psychological health (anxiety and depression) among persons aged 18-65 years. Descriptive and multivariate analyses were performed.

    Results: The prevalence and risk of anxiety and depression were high among people who were out of work. In the multiple regression analysis, compared to employed people, those who were not employed had a risk of anxiety of 7.76 (5.97-9.75) and 4.67 (3.60-5.74) for depression.

    Conclusion: The prevalence of anxiety and depression was higher among those who were out of labour marketas compared to those employed. Furthermore, people who were out of work had a higher risk of anxiety and depression. The odds were slightly higher for anxiety than for depression.

  • 7.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Alfredsson, J.
    Samhällsmedicin, Landstinget Gävleborg.
    Soares, Joaquim
    Mittuniversitetet, Avdelningen för hälsovetenskap.
    Stankunas, M.
    Department of Health Management, Lithuanian University of Health Sciences, Kaunas, Lithuania.
    Differences in health care-seeking behavior during economic recession2014In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 24, no Suppl. 2Article in journal (Other academic)
    Abstract [en]

    Background

    In Europe, equitable access to high-quality healthcare constitutes a key challenge for health systems across the continent. However, the recent economic recession left many outside the labour market, causing many to fall in poverty and social exclusion. Unemployment is probably the main factor leading to social exclusion. Studies which analysed health seeking behaviour among unemployed people have reported a variety of results, from low to high utilization of health services. However, some researchers argue that during stressful economic and social circumstances can cause high utilization of the health care system due to increased psychological disorders masked by physical complaints. This study examined differences in health seeking behaviour in Gävleborg County, which at the pick of the economic recession had high levels of unemployment as compared to the national average.

    Methods

    The data for the study come from the 2010 Survey of Health in Equal terms carried out in Gävleborg County, Sweden. The sample included 4245 persons aged 16-65 years. Descriptive and binary logistic analysis was used to assess differences in health seeking behavior by employment status.

    Results

    There was a statistical significant relationship between employment status and health-seeking behavior. Compared to employed persons, people who were out of the labor market had odds ratio of 1.42 (1.12-1.62) for contact with health care services; of 1.30 (1.12-1.50) for contact with a doctor in a health care facility and 1.67 (1.42-1.97) for contact with a doctor in a hospital. Controlling for age, sex, marital status, education, income, smoking habits, physical activity, self-rated health, and long standing illness removed the statistical significance of the observed relationships. Thus, the odds for contact with health care services went from.

    Conclusions

    At the pic of the recent economic recession, people who were outside the labor market had more contact with health care services, with doctor in hospitals as well as primary health care services as compared to employed counterparts. The differences in health seeking behavior were explained by demographic, socioeconomic and health variables.

    Key Words: Employment status, Health care, Gävleborg, economic recession.

    Key messages

    • People who were out of labor market in Gävleborg County in 2010 had more contact with health care services, with a doctor in hospital and primary health care respectively.

    • Future studies are warranted that can assess trends in health-seeking behavior among people outside Gävleborgs labor market.

  • 8.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Department of Health Science, Section of Public Sci ence, Mid-Sweden University, Sundsvall, Sweden; Department of Public Health Sciences, Karolinska In stitute, Stockholm, Sweden .
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    Alfredsson, Johanna
    Department of Community Medicine, Gävleborg County Council, Gävle, Sweden .
    Soares, Joaquim F. J.
    Mittuniversitetet, Avdelningen för Folkhälsovetenskap.
    Stankunas, Mindaugas
    University of Health Sciences, Kaunas, Lithuania.
    Employment status and health care utilization in a context of economic recession: Results of a population based survey in East Central Sweden2014In: Science Journal of Public Health, ISSN ISSN 2328-7942, EISSN 2328-7950, Vol. 2, no 6, p. 610-616Article in journal (Refereed)
    Abstract [en]

    Introduction: The most recent economic recession left many people outside the labour market world-wide, causing widespread poverty and social exclusion. Gävleborg County in East Central Sweden experienced massive layoffs caused by closure of various industries. Objective: The objective of this study was to investigate differences in health-care use according to employment status at the pick of the recent economic recession. Methods: The study used data from a cross-sectional survey “Health in Equal Terms” carried out in Gävleborg County in 2010. The sample included 4245 persons aged 16-65 years. Descriptive and logistic regression analyses were used to assess differences in health-care seeking behaviour by employment status. Results: Employment status was statistically significantly associated with health-care use in Gävleborg County. In the bivariate analysis people who were not employed had odds ratio of 1.62 (CI 1.18-1.72) for health care use as compared to their employed counterparts. Controlling for other variables in Model II to IV removed the statistical significance and reduced the odds to 0.44(CI 0.20-1.00). Conclusions: This study found that at the pick of the most recent economic recession, people who were out of work used more often health services as compared with their employed counterparts. The observed differences in health-care use were explained by demographic, socio-economic and health-related variables. Further studies are needed to analyze trends of healthcare utilization according to employment nationally, particularly at the county level.

  • 9.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science. Epidemiology Unit - ISPUP, University of Porto Medical School, Porto, Portugal.
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Ahmadi, Nader
    University of Gävle, Faculty of Health and Occupational Studies, Department of Social Work and Psychology, Social work.
    McGrath, Cormac
    Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Educating Public Health Professionals for an Unknown Future: Insight from a New Bachelor Programme Linking Health Promotion and Sustainable Development2017In: Research in Health Science, ISSN 2470-6205, Vol. 2, no 2, p. 70-78Article in journal (Refereed)
    Abstract [en]

    This paper aims to provide a description of the new bachelor programme “Health Promotion through Sustainable Development”, which started in autumn 2016 at the University of Gävle, Faculty of Health and Working Life. The programme was built integrating public health and biology through a thread of health promotion and sustainable development across the three years of study. In the era of sustainable development and more complex health threats, future public health professionals need to be equipped with the right knowledge and skills that will enable them to promote a sustainable population health.

  • 10.
    Macassa, Gloria
    et al.
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Walander, Anders
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences.
    Hiswåls, Anne-Sofie
    University of Gävle, Faculty of Health and Occupational Studies, Department of Occupational and Public Health Sciences, Public health science.
    Living in the Municipality of Gävle: Report on the Gävle Household, Labour Market Dynamics and Health Outcomes Survey - Wave 12013Report (Other academic)
    Abstract [en]

    In many industrialized countries including those in Europe, there is an established relationship between work conditions and health. For instance employment status and conditions have been reported to influence physical health (self-assessed health, pain and various somatic conditions), as well as mental health outcomes such as anxiety and depression, even if debate is still ongoing. Employment conditions have been suggested to be a key determinant of health inequalities, although this factor has been less researched than have education and income. Therefore, a study of the role played by employment status/conditions in a small geographical area such as Gävle Municipality (with its pattern of industries, plant and services closures, and high levels of unemployment) could contribute to knowledge on ways to reduce ill health related to labour market. 

     The overall aim of this study was to examine the relationship between employment status, household income and physical and psychological health outcomes among economically active people residing in Gävle Municipality, using data from Wave 1 of the Gävle Household, Labour Market Dynamics and Health Outcomes (GHOLDH) survey, a household panel survey carried out between April and June 2012. Data analysis was conducted using descriptive statistics and mixed multivariate models.

    There were differences in physical and psychological health by employment status. Individuals who were outside the labour market were more likely to report poor health, body pain and exhaustion than were individuals who were employed. In addition, those individuals who were outside work had a higher prevalence and risk of anxiety and depression. Data on household income also showed associations with physical and psychological health, with a concentration of poor self-reported health, somatic complaints, anxiety and depression in lower income households.

    Interestingly, the study findings revealed that anxiety was also prevalent among employed people, suggesting that people with insecure jobs might also be at risk of poor mental health. This finding requires further research to discern the role of precarious employment conditions on inequalities in physical and mental health outcomes. In addition, studies on the impact of gender on the relationship between employment status/conditions and physical and psychological health outcomes are warranted. To this end, the follow-up survey to be carried out in 2014 might provide additional knowledge pertaining to ways to reduce employment-related health inequalities within the municipality.

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