1 International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, 119 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
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Abstract |
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Methods Cross-sectional data of economically active male and female public sector employees aged 3560 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.
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.14 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?
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Methods |
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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 0100 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 healththe General Health Questionnairewhich 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.
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Results |
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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 gradein 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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Discussion |
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There was little evidence to support a strict interpretation of the role enhancement or role strain hypothesesa 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 householdthere 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.
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Summary |
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KEY MESSAGES
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Appendix A |
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Work-to-family conflict
To what extent do your job responsibilities interfere with your family life?
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Appendix B |
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Acknowledgments |
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References |
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