The health effects of jobs: Status, working conditions, or both?

Background: This study investigates whether the association of job strain and insecurity with health differs by status. Methods: A cross-sectional study of 2,249 employed workers aged 40-44 years conducted in two regions in south-east Australia in 2000 used a self-completed questionnaire to collect data. Multivariate analyses were used to compare depression, anxiety, physical health and general practitioner (GP) visits over 12 months across categories of job strain and insecurity for three status groups (high, middle and low). Results: High job strain and job insecurity were independently associated with poor mental health, poor physical health and visits to the GP for all status groups when adjusted for confounders. High job strain was associated with depression (OR=2.46, 95% CI 1.96-3.07), anxiety (OR=2.56, 95% CI 2.05-3.20), lower mean physical health scores (-1.11, 95% CI -1.98 - -0.23), and more visits to the GP (IRR=1.20, 95% CI 1.05-1.37). High job insecurity also showed significant associations with depression (OR=3.03, 95% CI 2.03-4.53), anxiety (OR=2.66, 95% CI 1.81-3.91), and GP visits (IRR=1.27, 95% CI 1.01-1.60). There were no significant differences by status in the associations of job strain and insecurity with outcomes. Conclusion: High-status workers were just as likely as low-status workers to be exposed to adverse work conditions and both status groups showed similar health effects. Implications: Exposure to insecure and high-strain jobs is likely to rise as economies and labour markets respond to globalisation and political change. High status may not protect employees from either exposure or impact, thus widening the population health consequences of adverse work conditions.