23 Mar 2015
A number of causal factors have been linked to the onset of depression in the older adult. Unemployment has been listed as one such causal factor. Considering the process of unemployment, the initial assumption was that the literature and research findings would indicate that there is a positive association between unemployment and depression. Even Freud in 1961 argued that the two great wellsprings of mental health are love and work. If Freud is correct then unemployment may lead to human disruption and pain worthy of our attention and understanding. In more recent literature it is also often disputed that job loss or unemployment produces profound life changes, including a loss of structured time, loss of valued working relationships, loss of purpose and meaningful life goals and the loss of status and identity (Marks and Evans, 2005). It is therefore unsurprising that depression may be a prominent mental health outcome in relation to job loss. However the debate continues as to whether unemployment results in psychological morbidity, or whether the association is due to those who are more vulnerable to mental illness becoming unemployed. In what follows research and theory on job loss will be reviewed, especially as it influences wellbeing, and in so doing, the evidence available concerning Freud's statement about the importance of work for mental health will be considered.
Firstly the concepts of unemployment, depression and their contemporary definitions will be explored. Secondly, introductions to the three most important theories in psychological unemployment research are presented. Having reviewed the literature, the findings of research studies that have been conducted in the area of job loss and depression will be offered. The limitations that exist in investigating whether or not a link exists between unemployment and depression will be discussed. This will allow an understanding of all of the factors that need to be considered before a valid association can be made between job loss and depression.
The concept of unemployment by the International Labour Office appears to be the basis for most modern national definitions of unemployment. This definition includes three core elements that represent an international compromise:
"The 'unemployed' consist of all persons above a specific age who during the reference period were:
(a) 'without work', i.e. were not in paid employment or in self-employment (...);
(b) 'currently available for work', i.e. were available for paid employment or self employment during the reference period; and
(c) 'seeking work', i.e. had taken specific steps in a specified reference period to seek paid employment or self-employment" (ILO, 2000a, p. 429).
This definition shows that unemployment is a multifaceted, multidimensional construct, involving not only situational aspects (non-employment), but also motivational aspects ("seeking work") and medical and legal aspects (being "available for work").
Depression has a domino effect on every aspect of the individual's life. Depression begins on a personal level but soon manifests to affect occupational performance and environmental structures such as family and social systems. Life satisfaction and general well-being are decreased significantly in depression. Major depression refers to "persistent and continuous depressed mood combined with a loss of interest or pleasure in the things that the person usually enjoys" (Gofrey & Denby, 2004, p.36). Disturbances of emotion are the hallmark of mood disorders such as depression. The individual may have powerful feelings of sadness, guilt, irritability, hopelessness and worthlessness. Cognitive functioning is impaired as problems start to manifest in concentration, memory, decision-making and thinking patterns (Zelnik & Howells, 2007). At an occupational level, occupational performance is greatly reduced across a variety of occupational domains including leisure, self-care and productive occupations. The individual lacks the energy and drive functions to engage in activities that were previously meaningful. At an environmental level, the individual may detach themselves from social and familial interactions. This leads to reduced social activity and loss of friends which gives rise to social isolation and further depression "in a downward spiral of ever decreasing engagement" (Gofrey & Denby, 2004, pg.36). Although these symptoms represent a major depressive episode, depression can also be minor in some individuals. Minor depression is a chronic or mild form of major depression that does not present with the full range of symptomology at any one time. Although it is not as severe as major depression, it can still affect the individual's quality of life.
The prevalence of depression in this population varies. According to Gatz (as cited in Kart & Kinney, 2001) mental disorders in later life such as depression, can be caused by understandable reactions to identifiable stressors. Unemployment is one such stressor. While losing a job at any age is stressful, those who are laid off at middle age seem to find the experience most difficult (Breslin & Mustard, 2003). For one thing they typically have more financial responsibilities than those in other age groups. Secondly older workers tend to remain out of work for a longer period of time than younger workers. Furthermore, persons of middle age are likely to display a strong career commitment, possibly making employment more significant for their well-being than it is for older workers who are close to the end of their careers, and for younger persons who are not yet completely incorporated in the world of work and employment (Lahelma, 1989). In addition, while persons of middle age have little access to other identity constructions beyond the work role, young persons may be able to find alternative identities in subcultures and older unemployed persons can categorise themselves not as "unemployed", but as "early retired", a process that is probable to buffer the negative mental health effects of unemployment (McFayden, 1995).
However, there are also arguments in opposition to the hypothesis that younger and older unemployed workers suffer less than middle-aged unemployed workers. The physical, social and emotional problems that are part of the maturation process may compound with the stress of unemployment among youths, making the experience of unemployment more harmful for them than for adults (Gurney, 1980). Moreover, older unemployed workers usually have greater difficulties in obtaining employment than middle-aged workers (Rife & Belcher, 1994). Nevertheless, the hypothesis that unemployment has particularly negative effects among middle-aged persons is well established in the research field and the arguments referring to high career commitment and strong financial responsibilities amongst middle-aged persons are indeed convincing.
All of those who experience role loss will not go on to develop depression. The meaning of the loss is unique to each individual. The vulnerability of the individual is also important in considering the onset of depression. The degree of vulnerability is dependent on what protective factors the individual has to combat risk factors that impact on the development of depression. Protective factors internal to the individual include self-esteem and a positive sense of self. External factors may include whether or not the individual is engaged in relationships that meet needs for physical and emotional intimacy and whether they are involved in social activities that sustain a sense of belonging and participation. The possession of such protective factors may aid the individual to cope with the changes of unemployment and thus prevent the onset of depression. However, if these protective factors are absent or impaired, the individual's susceptibility to developing depression is increased in the face of unemployment (Gofrey & Denby, 2004).
Several general psychological theories have been applied to the problem of unemployment, for example Weiner's (1985) attributional theory (Winefield, Tiggemann, Winefield, & Goldney, 1993), self-determination theory (Vansteenkiste, Lens, De Witte, De Witte, & Deci, 2004); social comparison theory (Sheeran, Abrams, & Orbell, 1995), alienation theory (Kieselbach, 1998) and object relations theory (Raber, 1996). However, the most prominent ones and ones that take into account the deterioration in wellbeing observed when people are exposed to job loss are: Jahoda's latent-deprivation model, Warr's vitamin model and Fryer's agency-restriction approach.
Firstly, Jahoda argued that paid work provides both manifest (associated with income) and latent benefits (associated with meeting psychological needs). People mainly participate in paid work to attain manifest benefits, but while employed gain from the five latent benefits of time structure, social contact, common goals, status and activity. Lack of employment leads to deprivation in both manifest and latent benefits, but it is the loss of the latent benefits that impact harmfully on psychological wellbeing. Jahoda (1984) argued that individuals, " have deep seated needs for structuring their time use and perspective, for enlarging their social horizon, for participating in collective enterprises where they can feel useful, for knowing they have a recognized place in society, and for being activeÃ¢â‚¬Â¦" (p. 298).
In current societies, employment is the only institution that can provide the latent functions in a sufficient amount. Other institutions, such as organised religion or voluntary associations, cannot serve as substitutes for employment to a satisfying degree (Jahoda, 1988). Therefore, according to this model, employment usually is necessary in order to be psychologically healthy, while unemployed persons are at danger of experiencing distress symptoms and a loss of well-being.
Warr's (1987) vitamin model is comparable to Jahoda's (1981, 1982, 1997) deprivation theory in assuming the environment to be the main determinant of a person's mental health. Both authors hypothesise that particular characteristics of the environment predict well-being, although the environmental aspects specified by Warr (1987) are not identical with those specified by Jahoda (1981, 1982, 1997): Opportunity for control, opportunity for skill use, externally generated goals, variety, environmental clarity, availability of money, physical security, opportunity for interpersonal contact, and valued social position. Warr (1987) hypothesised that the environment influences mental health "in a manner analogous to the effect of vitamins on physical health" (Warr, 1987, p. 9). Thus, low levels of the nine environmental features are assumed to have negative effects on mental health, while increasing levels are assumed to have positive effects on mental health. For some of the environmental features (e.g. physical security), very high levels are hypothesised to have no further impact at all. Other environmental features are even thought to be harmful in very high doses (e.g. variety). Unemployed persons are usually confronted with an environment that contains only some degree of each of Warr's (1987) "vitamins". According to this model this group of persons should thus be characterised by mental health problems.
Fryer (1986) criticised Jahoda's (1981, 1982, 1997) deprivation model for pragmatic, methodological, and empirical reasons, as well as for the view of human nature that is implied in the model. Situation-centred theories such as Jahoda's or Warr's are based on a analysis of the person as a passive, reactive, dependent, and mainly extrinsically motivated being according to Fryer. In contrast to this, Fryer (1986, 1997a) assumes humans to be "agents actively striving for purposeful self-determination, attempting to make sense of, initiate, influence, and cope with events in line with personal values, goals, and expectations of the future" (1997a, p. 12). However, unemployment severely restricts and frustrates agency as well as undermines planning and purposeful action because it is usually associated with poverty, future insecurity, and little social power. In other words: "agency theory tries to focus upon what people bring with them to a situation which is unfamiliar and problematical rather then upon what is taken away from them [by the loss of employment]" (1986, p. 16). In summary, in Fyer's (1986) agency restriction theory human beings are assumed to feel a "desire for self-directedness" (p. 16), which is frustrated by unemployment and the poverty that is often associated with unemployment, leading to distress and low well-being.
We can conclude that most common theories that have been applied to the predicament of unemployment or have been developed initially within the field of psychological unemployment research agree that unemployment is associated with distress and diminished well-being. These theories also predict that unemployment not only correlates with, but also actually causes distress.
Many reviews have been published that summarise and incorporate the results of nearly a century of scientific hard work concerning the psychological effects of unemployment. These reviews have provided important insights into the psychological effects of unemployment. However, most of these reviews have been written in the traditional narrative form, using varying standards of problem formulation, literature search, data extraction and evaluation, data analysis, as well as interpretation and presentation of results (Cooper & Hedges, 1994).
A prospective US study clearly showed that men aged 35-60 years who became unemployed had higher levels of depression and anxiety than those who remained employed. In this study the impact of stress on health in 300 middle aged men assessed every six months, men who became unemployed after entering the study were compared with an equal number, matched for age and race, who continued to work. Psychological and health data after unemployment were compared between the two groups by multivariate analysis of variance and covariance. After unemployment, symptoms of somatisation, depression, and anxiety were significantly greater in the unemployed than employed. Large standard deviations on self-esteem scores in the unemployed group suggested that some men coped better than others with job loss stress. However this study is limited by several factors: small sample size, some of the men's jobs may have been stressful and a third limitation is that it was not known whether the psychological declines observed in the group during the six month period began to occur prior to their unemployment, immediately after losing work or whether the observed adverse reactions would be subject to adaptation even if unemployment continued beyond six months.
Foster (1991) was the first researcher who used modern meta-analytic techniques in summarising and incorporating research results concerning the mental health effects of unemployment. His work, which he called an "exploratory meta-analysis" with the goal to "take a quick and dirty look at what a cross-study effect size might be" (p. 159), is not well known in the field, presumably because the author hid it in the appendix of his dissertation thesis. Foster integrated 22 effect sizes from 10 primary studies that had been recently published at the time he conducted his meta-analysis and computed an average (unweighted) effect size of d = 0.19. This is surprisingly small and seems to contradict the conclusions of earlier narrative reviewers, who concluded that being unemployed has a considerable negative effect on mental health.
Murphy and Athanasou's (1999) review of the effects of unemployment on mental health was particularly concerned with problems of causality. They wanted to know whether unemployment is merely correlated with distress, or whether it directly causes psychopathological symptoms and reduced well-being. The review included 16 longitudinal studies. The conclusion is in favor of direct causation of mental health problems by unemployment. The authors reported effect sizes of d = 0.36 for status-changes from employment to unemployment and of d = 0.54 for changes in the opposite direction. This means that unemployment was longitudinally linked with an increase in distress symptoms, whereas finding a new job was associated with a strong reduction of distress. The effects were of medium size. These longitudinal results provide support for the hypothesis that unemployment is not only correlated with distress, but actually causes distress.
In addition to computing overall effect sizes, Murphy and Athanasou (1999) conducted several moderator analyses: For nationality (Anglo-Saxon versus European), for age (young versus adult), for gender (male versus mixed gender), and for type of measurement procedure (General Health Questionnaire versus other instruments). No significant moderator effects were found. This, however, may be the result of low-test power, caused by the rather small number of primary studies incorporated in the Murphy and Athanasou (1999) meta analysis.
There was an absence of solid research evidence supporting retirement as a causal factor of depression in older adults.
The concept of unemployment and the onset of depression in middle aged adults are two complex areas that are not easily defined. This makes it difficult to determine whether or not there is an association between them. A number of internal and external factors shape the unemployment process. External factors may include cultural norms, family responsibilities, working conditions, job status and available income after retirement. Internal factors include the individual's expectations, satisfaction with work, health situation and the personal meaning of work and leisure. Also, the conditions and circumstances that surround the unemployment need to be taken into account. This variation in work and unemployment experiences makes it difficult to assess whether or not unemployment has an association with the prevalence of depression in middle-aged adults. Also, due to variances in the definition of depression, prevalence figures vary from survey to survey. Furthermore, there appears to be no solid research evidence linking depression to any one causal factor.
Having reviewed all of the available literature on this subject, a number of conclusions can be drawn. It was expected that unemployment would be positively associated with the onset of depression in middle aged adults. The literature on depression and unemployment offered support to my original assumption. As the literature was based on theory and assumptions, rather than solid research evidence, I decided to review a number of research studies conducted in this area. On review of the research studies, it became apparent that there was limited research evidence in support of my assumption. Most research studies referred to the global construct of 'mental health' rather than specifically analysing depression. Thus, we do not know yet how strong the effects of unemployment are on the individual facet of depression but it is clear that unemployment leads to reduced well being and distress. The findings of the research studies also generated conflicting evidence. Considering both the literature and the research studies carried out in this area, there appears to be no definitive answer to my question. As outlined previously, unemployment and depression in older adults are two very complex areas that are underpinned by a number of factors. This makes it difficult to reach a definitive answer. The experience of unemployment is subjective to each individual and is shaped by a number of personal, occupational and environmental factors. This makes it difficult to investigate on what grounds is there an association between unemployment and depression due to a range of impending factors. Future research in this area would be required in order to delve deeper into the topic and uncover clear answers. Identifying those who are at high risk for psychological problems and finding ways of preventing them from suffering the adverse effect of unemployment are important areas for further study.
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