Household Food Insufficiency, Financial Strain, Work–Family Spillover, and Depressive Symptoms in the Working Class: The Work, Family, and Health Network Study

摘要

Objectives. We evaluated the association of household-level stressors with depressive symptoms among low-wage nursing home employees. Methods. Data were collected in 2006 and 2007 from 452 multiethnic primary and nonprimary wage earners in 4 facilities in Massachusetts. We used logistic regression to estimate the association of depressive symptoms with household financial strain, food insufficiency, and work–family spillover (preoccupation with work-related concerns while at home and vice versa). Results. Depressive symptoms were significantly associated with household financial strain (odds ratio [OR] = 1.82; 95% confidence interval [CI] = 1.03, 3.21) and food insufficiency (OR = 2.10; 95% CI = 1.10, 4.18). Among primary earners, stratified analyses showed that food insufficiency was associated with depressive symptoms (OR = 3.60; 95% CI = 1.42, 9.11) but financial strain was not. Among nonprimary wage earners, depressive symptoms correlated with financial strain (OR = 3.65; 95% CI = 1.48, 9.01) and work–family spillover (OR = 3.22; 95% CI = 1.11, 9.35). Conclusions. Household financial strain, food insufficiency, and work–family spillover are pervasive problems for working populations, but associations vary by primary wage earner status. The prevalence of food insufficiency among full-time employees was striking and might have a detrimental influence on depressive symptoms and the health of working-class families. Depression is among the most commonly experienced disorders and is a leading cause of disability worldwide. 1 Increasing evidence suggests that depression is a leading cause of sickness-related absence in the labor force and is a concern for employers and employees alike. 2 Women, people in lower socioeconomic positions, and racial/ethnic minorities have higher rates of depression than the general population, whether they are in the workforce or not. 3 Some evidence suggests, however, that the higher prevalence of depression observed in disadvantaged groups may stem from stressors associated with their common experiences rather than from race/ethnicity, income, or gender per se. 3–5 Several studies have established that the presence of persistent negative and stressful experiences may lead to depression. 6–9 Evidence shows that work-related strain, specifically job strain (high demand/low control) and emotional strain, is associated with depression, especially among caregiving workers. 7–9 The work–family literature suggests that work–family spillover (preoccupation with work impinging on home life or preoccupation with personal responsibilities impinging on work) may be correlated with depression. 10 Fewer studies, however, have explored the contribution of both household- and work-related stressors to depression. The inability to provide for one's family despite working full time could be a significant source of stress. 11 Indeed, household financial strain and food insufficiency (sometimes or often not having enough food to eat) are considered particularly stressful, 12–15 especially for low-income populations. 16,17 Studies have found separate associations between financial strain and food insufficiency and adverse mental health outcomes. 12,17–22 However, these studies concentrated on populations with obvious disadvantages, such as the unemployed and elderly people with disabilities. Thus, the extent and deleterious effects of both household financial strain and food insufficiency—along with work–family spillover—on working-class households have not been fully examined. Nursing home workers are a growing part of the workforce who may face higher rates of household food insufficiency, financial strain, and work–family spillover. 23,24 Among nursing assistants—the biggest work group in nursing homes, and among the lowest paid—the proportion of women is estimated to be 80% to 90%; most are single mothers and are thus the primary wage earners for their families. 23,25 Nursing home workers are more likely to be recent immigrants who may not be aware of or eligible for government benefits. 24 A majority of these low-wage earners are also members of racial/ethnic minority groups. 25 Research has not fully explored the relationship between household- and work-related stressors and mental health outcomes, particularly among working-class households. We examined work and home conditions—household financial strain, food insufficiency, and work–family spillover—associated with depressive symptoms in a low-wage, multiethnic group of women and men employed in the long-term care industry. Because previous studies did not examine these factors jointly, our first objective was to assess the multivariate association of each exposure with depressive symptoms. We then determined whether the association between these exposures remained in a model incorporating all 3 main variables. We hypothesized that depressive symptoms associated with these variables would be more significant and stronger for people who wer