Does conflict between home and work explain the effect of multiple roles on mental health? A comparative study of Finland, Japan, and the UK

Tarani Chandola1, Pekka Martikainen1,2, Mel Bartley1, Eero Lahelma3, Michael Marmot1, Sekine Michikazu4, Ali Nasermoaddeli4 and Sadanobu Kagamimori4

1 International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, 1–19 Torrington Place, London WC1E 6BT, UK. E-mail: tarani{at}public-health.ucl.ac.uk
2 Population Research Unit, Department of Sociology, PO Box 18, FIN-00014, University of Helsinki, Finland
3 Department of Public Health, PO Box 41, FIN-00014, University of Helsinki, Finland
4 Department of Welfare Promotion and Epidemiology, Toyama Medical and Pharmaceutical University, 2630 Sugitani, Toyama 930-0194, Japan


    Abstract
 Top
 Abstract
 Methods
 Results
 Discussion
 Summary
 Appendix A
 Appendix B
 References
 
Background Although there have been a number of studies on the effects of multiple roles on health and how a combination of work and family roles may be either advantageous (role enhancement) or disadvantageous (role strain) for health, there has been relatively little investigation on the psychosocial content of such roles. Work-to-family conflict and family-to-work conflict could arise from inability to combine multiple roles and result in stress and ill health. The question of whether both types of conflict mediate between the association of multiple roles with health has not been analysed before. This paper sets out to investigate whether: (1) work-to-family conflict or family-to-work conflict contributes towards explaining the association of multiple roles with mental health; (2) the effect of work-to-family conflict and family-to-work conflict on mental health varies by gender; (3) the effect of work-to-family and family-to-work conflict on mental health vary between countries with different welfare state arrangements and social norms.

Methods Cross-sectional data of economically active male and female public sector employees aged 35–60 in London (UK), Helsinki (Finland), and the West Coast of Japan. Linear regression models (separate for each gender and cohort) of SF-36 mental component scores were analysed with role combinations, family-to-work and work-to-family conflict as explanatory variables.

Results Single fathers in all three cohorts and of single mothers in the Helsinki cohort had poor mental health, and this was partly explained by their higher levels family-to-work conflict. Both types of conflict affect the mental health of men and women independently of each other. Japanese women had the greatest conflict and poorest mental health while Helsinki women had the lowest conflict and best mental health.

Conclusion Both work-to-family and family-to-work conflict affect the mental health of men and women in three different countries. Work and family roles and the balance between the two may be important for the mental health of men and women in industrialized societies. Any analysis of the effect of multiple roles on health needs to take into account the psychosocial content of such roles.


Keywords Role strain, role conflict, SF-36, mental health, comparative, psychosocial, gender

Accepted 26 January 2004

There has been considerable research on the work-to-family interface in recent years. The questions around the work-to-family interface have been guided, in part, by the increasing rate of participation by women, including those with young children and other family responsibilities, in the labour force. A large part of the research literature on the social determinants of women's health has tended to focus on the multiple roles women occupy and how a combination of these roles may be either advantageous (role enhancement) or disadvantageous (role strain) for their health.1–4 However, there has been relatively little research into the psychosocial content of these roles and the pathways leading from roles to health and illness. One of the ways of investigating such psychosocial pathways could be through research into the effect of work-to-family and family-to-work conflict on health.

Work-to-family conflict occurs when efforts to fulfil the demands of the employee role interfere with the ability to fulfil the demands of the roles as a spouse, parent, or carer. Frequent work-to-family conflict may represent an impediment to successfully meeting family-related demands and responsibilities, and may undermine a person's ability to construct and maintain a positive family-related self-image.5 Conversely, family-to-work conflict may be an obstacle to successfully meeting work-related demands and responsibilities, thereby undermining a person's ability to construct and maintain a positive work-related self-image. As both employee and family roles represent core components of adult identity, impediments to work- and family-related identity formation and maintenance are likely to be experienced as stressful.5 One of the most consistent and strongest findings in this research literature is the significant relationship between such conflict and stress-related health outcomes including psychological strain, anxiety and depression, somatic complaints, elevated blood pressure, and alcohol abuse (see Allen et al.6 for a systematic review).

The hypotheses on multiple role strain, arising from conflicts between employment, and marital and parental roles, assume that family-to-work conflict and work-to-family conflict are the psychosocial processes that arise from multiple roles and that such conflict may lead to stress and ill health. Eagle et al.7 found that divorced people with children in the household reported the highest levels of family-to-work conflict followed by married people with working partners and children in the household. Overall, respondents with children reported higher levels of family-to-work conflict than respondents without children. One of the most consistent observations from the literature on multiple roles is that single parents (and single mothers, in particular) have the poorest health. It is possible that their poorer health may arise, in part, due to conflicts between family and work domains. However, such hypotheses have seldom been empirically tested.

Furthermore, the effect of both types of conflict on health may differ by gender. Some reports7,8 found that men reported higher levels of work-to-family conflict than women while other studies did not find gender differences.9 Frone10 suggests that the effect of work-to-family conflict on mental health may be stronger among women than men. He suggests that as women have traditionally been socialized to give priority to the homemaker and maternal roles, any conflict affecting the family role and resulting in family-related strains may consequently have greater adverse effects on the mental health of women compared with men. Conversely, he hypothesizes that family-to-work conflict may have stronger effects on the mental health of men. Men have traditionally been socialized to give priority to the breadwinner role, so that any conflict affecting the employee role may have greater adverse effects on the mental health of men compared with women. Evidence for an independent effect of both work-to-family and family-to-work conflict in both men and women could suggest that the employee and family roles are becoming more central to lives of both men and women.

The analysis of data from different countries may provide further information on the psychosocial context of role strain on health. Differences between countries in the provision of family friendly work arrangements, such as flexi-time working or child-care provision, or in gender-related social norms, such as attitudes towards the division of household labour, may result in differences between countries in the extent of work-to-family and family-to-work conflict, and how these affect mental health. Industrial societies such as Japan may have greater traditional attitudes to the gender division of household labour11 although the career structures of Japanese women are starting to resemble those of Japanese men.12 Even within the civil service, generally regarded as the most gender-blind occupational sphere in Japanese society, there remain strongly traditional attitudes to the career tracks of women, resulting in the gender stratification of the labour force.13,14 Women working in traditional occupational groups such as nursing, who try to maintain their roles as housewives and mothers, are most likely to suffer stress-related burnout.15 These traditional gender attitudes at work and at home may result in stronger effects of work-to-family and family-to-work conflict on the health of Japanese women compared with women from other industrialized societies.

Finland, like other Nordic countries, has extensive child-care systems, generous parental leave and family leave benefits and rules that allow rearrangements of work time for parents of small children.16,17 The full-time labour force participation rate of Finnish women is high by international standards (latest statistics available from the Organization for Economic Co-operation and Development-www.oecd.org) and is at least partly explained by such family-friendly working conditions. In contrast, in countries such as the UK, there has been strong emphasis on market forces with relatively little interference by the State in the economic arrangements of the family. Until recently, there were no systems of parental leave in the UK.16,17 Unlike in Japan, where large firms are well known for providing various types of assistance for families as part of the ‘life-time employment system’,18 economic support for families in the UK has traditionally been considered to be both outside the public domain (the ‘Nordic model’) and also not the responsibility of companies (the ‘Japanese model’).17 As a consequence, work-to-family conflict may have greater effects on the health of British employees compared with Japanese or Finnish employees. However, the lack of integration of Japanese women into the life-time employment system in Japanese firms could result in few women enjoying the benefits of such family assistance provided by companies.

The aim of this study is to examine whether work-to-family and family-to-work conflict explain the effect of role strain on mental health among male and female public sector employees from Britain, Finland, and Japan. We ask the following research questions:

Does work-to-family conflict or family-to-work conflict contribute towards explaining the association of multiple roles with mental health?

Does the effect of work-to-family conflict and family-to-work conflict on mental health vary between men and women? Is the effect of work-to-family conflict on mental health greater for women and the effect of family-to-work conflict greater for men?

Do employees in countries with family friendly working policies have better mental health as a result of lower work-to-family conflict? Do employees (and women employees in particular) in countries with traditional gender attitudes have poorer health as a result of greater family-to-work conflict?


    Methods
 Top
 Abstract
 Methods
 Results
 Discussion
 Summary
 Appendix A
 Appendix B
 References
 
Data
Participants of the Japanese, Finnish, and British cohorts were recruited from municipal, provincial, and national civil service employers, and were sent a standardized questionnaire. In Japan, data were obtained from the civil servants of a local government,19 in 1998–1999. The Finnish data derived from the Helsinki Health Study baseline survey including municipal employees from the City of Helsinki in 2000–2001.20 The British cohort comprised of employees working in National Government Civil Service departments in London recruited in 1985–1988 (the Whitehall II study).21 For this study, we included men and women who participated in the baseline of the Japanese and Finnish studies or in the third phase of the British study (1991–1993) and were economically active and 35–60 years old at that time. Altogether, 1865 participants from Japan, 5886 from Helsinki, and 6955 from London were included.

Variables
Roles
As the analysis was only done for those in employment, the multiple roles variable consisted of four categories. In terms of increasing number of roles, these were non-married respondents (including never married, divorced, separated, and widowed) without children (aged <16) living in the household, married (or cohabiting) respondents without children, non-married respondents with children (or ‘single parents’), and married (or cohabiting) with children. Single parents are assumed to have greater demands and strain than married parents with children as they could be expected to adopt the roles of both parents and have full responsibility for housekeeping and care for children. Accordingly, we would expect single parents to have the poorest mental health, followed by married respondents with children, then married respondents without children, and then by single respondents without children living in the household.

Conflict
Work-to-family conflict and family-to-work conflict were measured by four question items each (Appendix A) which were adapted from the National Study of Midlife Development in the US (MIDUS).22 Each question was scored so that a higher score reflected greater conflict. Principal components analysis suggested that there were two main factors (work-to-family and family-to-work conflict) that explained around 50% of the total variance in the items in these data. The question items were then summed to create separate scales for work-to-family and family-to-work conflict (with scores from 4 to 12). These scales showed a fairly high degree of internal reliability (Cronbach alpha coefficients for family-to-work conflict and work-to-family conflict ranged from 0.64 to 0.74 in the three cohorts) and were moderately correlated with each other (Pearson correlation coefficient ranged from 0.34 to 0.50). Other studies have provided further evidence on the reliability and validity of these scales.23 Both the work-to-family and family-to-work conflict variables are used as continuous variables or were grouped into country-specific tertiles for the analysis.

Health
Mental health was measured by the SF-36 mental health component score (MCS). MCS scores range from 0–100 and a higher score indicates better health. The MCS has been validated against external criteria (diagnosed clinical depression)24 and is correlated strongly (–0.70 to –0.75) with another measure of mental health—the General Health Questionnaire—which was only available for the London and Helsinki cohorts.

Analysis
Initially, linear regression models of mental health (SF-36 MCS scores) were analysed separately for each of the countries and by gender. These models analysed the age-adjusted effects of the explanatory variables separately and together (multiple roles, work-to-family conflict and family-to-work conflict). If the association between multiple roles and MCS scores reduces after adjusting for the conflict measures, this suggests that such conflict may (statistically) explain some of this association. In order to compare the effects of work-to-family and family-to-work conflict on mental health in all three countries and both genders, data from the three cohorts and both genders were pooled and interaction effects between gender, cohort, and the conflict variables were analysed.


    Results
 Top
 Abstract
 Methods
 Results
 Discussion
 Summary
 Appendix A
 Appendix B
 References
 
Table 1 looks at descriptive statistics for the variables in the analysis. Women from the London cohort were, on average, the oldest among the cohorts. There were relatively fewer women with children living at home in the London cohort, although this may be due to their older age. On average, men and women in the Helsinki cohort had the lowest levels of either work-to-family or family-to-work conflict. There was little evidence of a gender difference in either type of conflict in the Helsinki cohort. On the other hand, there was some evidence of a gender difference in the average levels of work-to-family conflict in the London and Japanese cohorts although these differences were in opposite directions. London men reported higher levels of work-to-family conflict compared with women, while in contrast, Japanese women reported higher levels of both work-to-family conflict and family-to-work conflict compared with men. Japanese women reported higher levels, on average, of both types of conflict for all cohorts and gender groups. The average levels of mental health were broadly similar for men and women in the London and Helsinki cohorts but were markedly lower (i.e. poorer) for Japanese men and women. In all three cohorts, single parents had the poorest mental health although there were very few single parents in Japan.


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Table 1 Descriptive statistics for main variables in the analysis

 
The mean (and 95% CI) work-to-family and family-to-work conflict scores by family roles are examined in Table 2. In all three cohorts single parents and married parents, on average, had higher levels of family-to-work and work-to-family conflict. Helsinki women had the lowest level of either type of conflict in all role combinations, while Japanese women had the highest levels. Similarly, Helsinki men tended to have the lowest levels of conflict in all role combinations while Japanese men tended to have the highest levels of conflict.


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Table 2 Mean (and 95% confidence intervals) of work-to-family and family-to-work conflict by domestic roles

 
Table 3 examines the linear regression of the SF-36 mental health scores with multiple roles, family-to-work and work-to-family conflict as the explanatory variables adjusted for age with separate models for each country and gender. In the first column (for men), only multiple roles were entered into the regression model. In the second column, the effect of multiple roles was adjusted for family-to-work conflict. In the third column, the effect of multiple roles was adjusted for work-to-family conflict. If the effect of multiple roles on mental health reduces in the second or third columns, this would imply that either family-to-work or work-to-family conflict explains some of the effect of multiple roles on mental health. This analysis was then repeated in the (three) columns for women.


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Table 3 Linear Regression of SF-36 Mental Component Scores (MCS), with age, family-work (F-W) conflict, work-family (W-F) conflict, and Domestic Roles—separate cohorts analysis

 
In the London cohort, for men, single fathers have the poorest mental health compared with men with other role combinations. Although married fathers have better mental health than single fathers, this does not necessarily imply evidence in favour of role enhancement as married men without children have better health than married fathers. When adjusted for family-to-work conflict, the gap in mental health between single fathers and other role combinations reduces, implying that family-to-work conflict may explain some of the effect of strain of single fatherhood on mental health in London. When adjusted for work-to-family conflict, the health advantage of married men remains unchanged implying that work-to-family conflict may not explain the poorer mental health of single fathers. Among London women, in the model adjusted for age and multiple roles only, there was little evidence for either role strain (single mothers did not have poorer mental health) or role enhancement (married mothers did not have better mental health compared with married women without children).

For Helsinki men and women, there was some evidence of single fathers and single mothers having poorer mental health compared with those with other role combinations. As observed among London men, the gap between the mental health of single parents in Helsinki and respondents with other role combinations reduced, in particular, when adjusted for family-to-work conflict. Although there were only five single fathers in the Japanese cohort, there was some evidence of poor mental health which reduced when adjusted for family-to-work conflict. There was little evidence of role enhancement as married fathers in Japan did not have better mental health compared with married men without children living at home. Among Japanese women, there was little evidence of significant differences in mental health between the roles.

Among men and women in all three cohorts, increasing conflict of either type was associated with decreasing mental health. Among London women, family-to-work conflict appeared to have a greater detrimental effect on mental health compared with London men and this gender difference was statistically significant (Appendix B). However, among the other cohorts, there was little evidence of such gender differences in the effect of either types of conflict on health. Furthermore, both types of conflict remained significantly associated with poorer mental health independent of each other (Appendix B). The estimates of mental health for each of the domestic roles did not change much compared with Table 3 (analysis not shown). In addition, adjusting for social position (employment grade—in Appendix B) did not substantially change the results from Table 3. In the Helsinki and Japanese cohorts, employment grade was not significantly associated with mental health, whereas in the London cohort, those in lower grades had poorer health. The London cohort also had information on caring for elderly relatives and adjusting for this did not change the associations between the conflict measures and health much (analysis not shown). However, adjusting for family-to-work conflict reduced the significant association between caring and poorer mental health to non-significance in both men and women.

Table 4 brings the three cohorts together into the same regression models separately by gender. With the Helsinki cohort as the reference group, there was little difference in the mental health scores between Helsinki and London men, but Japanese men had the poorest mental health (their average scores on the MCS were 4.5 less than the average score for Helsinki men). Among women, Helsinki women had the best mental health while Japanese women had the poorest health. When adjusted for work-to-family conflict, the difference between Helsinki and Japanese women and between London and Japanese women reduced. When adjusted for family-to-work conflict, the difference in mental health between Helsinki and London women and between Helsinki and Japanese women reduced. Among men, adjusting for either type of conflict only increased the difference in mental health between Japanese men and the other two cohorts.


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Table 4 Linear Regression of SF-36 Mental Component Scores (MCS), with age, grade, family-work (F-W) conflict, work-family (W-F) conflict, and Domestic Roles—combined cohorts analysis

 

    Discussion
 Top
 Abstract
 Methods
 Results
 Discussion
 Summary
 Appendix A
 Appendix B
 References
 
The effects of multiple roles on health
This paper set out to examine whether work-to-family and family-to-work conflict explains the effects of different role combinations on mental health among male and female public sector employees from three different industrial countries, Britain, Finland, and Japan. All participants in the three studies were employed, so the paper examines the effects on mental health of the additional roles of parent and spouse. There was some evidence that the poorer mental health of single fathers in all three cohorts was explained, in part, by their higher levels family-to-work conflict. Similarly, the poorer mental health of single mothers in the Finnish cohort appeared to be explained, in part, by their higher levels of family-to-work conflict. Other studies4 have further found that socioeconomic and material circumstances did not explain the poorer health of Finnish lone mothers and have suggested that lone mothers may be suffering from multiple burdens of combining parental and work roles without the support of a partner. However, it is also clear that neither type of conflict explains all the differences in mental health between family roles.

There was little evidence to support a strict interpretation of the role enhancement or role strain hypotheses—a greater number of roles were not unequivocally associated with better or poorer mental health in all three cohorts for both men and women. However, there was some evidence of higher demands and strain among single fathers in all three cohorts and among single mothers in the Helsinki cohort. Married mothers and fathers did not have better mental health than married men and women without children living in the household—there was little evidence that ‘more roles result in better mental health’ in either men or women, in these employed cohorts.

The effects of work-to-family and family-to-work conflict on health
Both work-to-family and family-to-work conflict appears to affect the mental health of men and women independently of each other. There was evidence that the effect of family-to-work conflict on mental health in the London cohort was stronger for women, while little evidence of gender differences in either type of conflict within the Japanese and Helsinki cohorts. This is contrary to Frone's hypothesis that family-to-work conflict should have a stronger effect on the mental health of men. It appears that both types of conflict have significant effects on the mental health of both men and women.

In terms of whether differences between countries in gender norms and family-friendly employment policies affect mental health, men and women in Finland had the best mental health and the lowest conflict of either type (this was true for all role combinations). Furthermore, when adjusted for family-to-work and work-to-family conflict, the difference in mental health between Helsinki women and women from the other cohorts reduced a little. This suggests that the better mental health of working Finnish women could be attributable, in part, to their lower conflicts between work and family and vice versa. The family-friendly work policies in Finland may contribute to their lower levels of conflict and better mental health, especially for women. Correspondingly, the poorer mental health of working Japanese women could be attributable, in part, to their higher levels of work-to-family conflict. The gender stratification of the Japanese labour force,14 along with traditional gender attitudes to domestic labour,13 could result in higher levels of work-to-family conflict among Japanese women and consequently poorer mental health.

Methodological considerations
There are a number of caveats to the analysis in this paper. Cross-sectional data from all three cohorts were analysed making it difficult to disentangle cause from effect. However, longitudinal data from the London cohort were available and separate analysis (not shown) found that both types of conflict predicted changes in SF-36 mental component scores (after four years), even after adjusting for negative affect at baseline. Another problem with the analysis is the possible difference in the meaning of SF-36 scores in the three cohorts. Although, the (translated) SF-36 questionnaires have been validated in Japan, Finland, and the UK, the lower scores, on average, for both men and women from the Japanese cohort suggests that there may be differences in meaning of the SF-36 mental health questions for the Japanese cohort compared with the two Western European cohorts. The cohorts in all three countries comprise public sector employees and may not be representative of the general population, although the gender patterning of family roles in the London cohort is similar to other large employers in the UK.25

Furthermore, there are differences between the countries in terms of the types of civil service jobs represented in the cohorts. The London cohort was based on people working for the national civil service which does not include professions such as teachers and nurses who are represented in the municipal and provincial civil services of Helsinki and Japanese respectively. The Helsinki cohort also included other female-dominated jobs such as child minders and assistant nurses and had a larger proportion of women working part time (13% working <30 hours/week, compared with 8% in London and 4% in Japan) which may have contributed to their lower levels of conflict between work and family, although part-time employment was not directly related to mental health. Moreover, direct comparisons with other studies on the effect of multiple roles on the health of men and women may not be straightforward as the analysis in this paper is only carried out on employed people.


    Summary
 Top
 Abstract
 Methods
 Results
 Discussion
 Summary
 Appendix A
 Appendix B
 References
 
In terms of policy implications of this research, it appears that both work-to-family and family-to-work conflict may affect mental health independently of each other. This suggests that work and family roles and the balance between the two are important for the mental health of male and female employees in industrialized societies. Any analysis of the effect of multiple roles on health needs to take into account the psychosocial content (such as conflict) of such roles. The lower average levels of both types of conflict in the Helsinki cohort may be attributable to the Finnish welfare state's arrangements in supporting men and women in terms of family-friendly employment policies. The take-up of such policies may become necessary as paid work becomes an increasingly central feature of women's lives in industrialized societies.


KEY MESSAGES

  • Conflicts between family and work roles appear to have detrimental effects on the mental health of men and women from different industrialized societies.
  • Men and women in Finland had the best mental health and the lowest work-to-family and family-to-work conflict.
  • The better mental health of Finnish women could be attributable, in part, to their lower conflicts between work and family which may arise from their family-friendly employment conditions.

 


    Appendix A
 Top
 Abstract
 Methods
 Results
 Discussion
 Summary
 Appendix A
 Appendix B
 References
 
Family-to-work conflict
To what extent does your family life and family responsibilities interfere with your performance on your job in any of the following ways?
Would you say:-

Not at all

To some extent

A great deal

Not applicable

a. Family matters reduce the time you can devote to your job 1 2 3
b. Family worries or problems distract you from your work 1 2 3
c. Family activities stop you getting the amount of sleep you need to do your job well 1 2 3
d. Family obligations reduce the time you need to relax or be by yourself 1 2 3

Work-to-family conflict
To what extent do your job responsibilities interfere with your family life?
Would you say:-

Not at all

To some extent

A great deal

Not applicable

e. Your job reduce the amount of time you can spend with the family 1 2 3
f. Problems at work make you irritable at home 1 2 3
g. Your work involves a lot of travel away from home 1 2 3
h. Your job takes so much energy you don't feel up to doing things that need attention at home 1 2 3


    Appendix B
 Top
 Abstract
 Methods
 Results
 Discussion
 Summary
 Appendix A
 Appendix B
 References
 
Linear Regression of SF-36 Mental Component Scores (MCS), with age, family-work (F-W) conflict, work-family (W-F) conflict, domestic roles, gender and grade
Men and Women

Adjusted for age and roles and

London

Helsinki

Japan

Gender

    Men 0.00 0.00 0.00
    Women 0.68 –0.07 –1.73
F-W conflict

    Low conflict (lowest tertile) 0.00 0.00 0.00
    Average conflict –1.60** –0.68 –1.67*
    High conflict (highest tertile) –5.00** –5.89** –7.13**
Gender * F-W conflict

    All men and women with low conflict 0.00 0.00 0.00
    Women with average conflict –0.69 –0.38 –0.63
    Women with high conflict –2.11** 0.07 1.81
W-F conflict

    Low conflict (lowest tertile) 0.00 0.00 0.00
    Average conflict –1.39** –3.56** –3.46**
    High conflict (highest tertile) –4.06** –5.73** –5.22**
Gender* W-F conflict

    All men and women with low conflict 0.00 0.00 0.00
    Women with average conflict –0.65 1.92 1.94
    Women with high conflict –0.65 0.29 –1.04

Men

London

Helsinki

Japan

F-W conflict

    Low conflict (lowest tertile) 0.00 0.00 0.00
    Average conflict –1.63** –0.78 –1.69*
    High conflict (highest tertile) –5.01** –5.56** –6.99**
W-F conflict

    Low conflict (lowest tertile) 0.00 0.00 0.00
    Average conflict –1.48** –3.88** –3.37**
    High conflict (highest tertile) –4.16** –5.76** –5.18**
    Grade (higher score = lower grade) –0.67** 0.59 –0.63

Women

London

Helsinki

Japan

F-W conflict

    Low conflict (lowest tertile) 0.00 0.00 0.00
    Average conflict –2.23** –1.06** –2.26
    High conflict (highest tertile) –7.16** –5.84** –5.33**
W-F conflict

    Low conflict (lowest tertile) 0.00 0.00 0.00
    Average conflict –1.93** –1.66* –1.62
    High conflict (highest tertile) –4.59** –5.41** –6.06**
    Grade (higher score = lower grade) –0.90** 0.31 0.80


    Acknowledgments
 
This work is part of the European Science Foundation program on Social Variations in Health Expectancy in Europe, in particular the working group on work-stress models. The Helsinki Health Study is supported by grants from the Academy of Finland, Research Council for Health (48119, 48553, and 53245) and the Finnish Work Environment Fund (99090). The Whitehall II study has been supported by grants from the Medical Research Council, British Heart Foundation, Health and Safety Executive, National Heart Lung and Blood Institute (HL36310), National Institute on Aging (AG13196), Agency for Health Care Policy Research (HS06516), The New England Medical Centre: Division of Health Improvement, Institute for Work and Health, Toronto, and the John D and Catherine T MacArthur Foundation Research Networks on Successful Midlife Development and Socio-economic Status and Health. TC is supported by an ESRC grant (RES-000-22–0290). PM has a fellowship and a grant (70631, 48600) from the Academy of Finland. MM is supported by a United Kingdom MRC Research Professorship. We wish to thank participating civil servants in Japan, Helsinki, and London, and the research teams in all collaborating centers. Elina Nihtilä helped in carrying out the analyses and preparing the tables.


    References
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 Abstract
 Methods
 Results
 Discussion
 Summary
 Appendix A
 Appendix B
 References
 
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