The worries of working : Longitudinal studies on the impact of employment uncertainty and employment transitions on clinically defined mental health conditions

While mental health problems according psychotropic drug purchases and sick leave spells for psychiatric disorders have increased in Sweden the past 15 years, this is not reflected in trends of psychiatric diagnoses or suicide mortality. In parallel, labor markets have undergone structural changes pressuring employers to increase their flexibility to ensure permanence. In consequence, this may introduce greater uncertainty about employment continuity and involuntary job transitions for the employees. While evidence suggest that employment uncertainty increases the risk of self-reported mental health problems, the relation to clinically pertinent mental health conditions remains unclear. Therefore, this thesis aimed to investigate if employment uncertainty and involuntary labor market transitions, was associated with common and with severe clinically defined mental health conditions. All four studies relied on national health registers for ascertainment of clinically defined mental health conditions. Studies I and II relied on information from registers to operationalize downsizings/workplace closures, while Study III and IV obtained information about cognitive and affective job insecurity from the Longitudinal Occupational Survey of Health and the Swedish Work Environment Survey, respectively. According to Study I, employees who left the downsizing organization for another or no job increased their purchases of psychotropic drugs prior to the downsizing more than unexposed employees, while their purchases decreased in connection to the exits. For employees staying in the organization, psychotropic drug purchases increased from 1 year before the downsizing to 4 years after, particularly in close proximity to the downsizing. Study II showed that older employees exposed to downsizing/workplace closure before permanently exiting into old age retirement, sickness absence/disability pension or unemployment exhibited a smaller or no decline in psychotropic drug purchases d