Employment status and health after privatisation in white collar civil servants: prospective cohort study.
OBJECTIVE
To determine whether employment status after job loss due to privatisation influences health and use of health services and whether financial strain, psychosocial measures, or health related behaviours can explain any findings.


METHODS
Data collected before and 18 months after privatisation.


METHODS
One department of the civil service that was sold to the private sector.


METHODS
666 employees during baseline screening in the department to be privatised.


METHODS
Health and health service outcomes associated with insecure re-employment, permanent exit from paid employment, and unemployment after privatisation compared with outcomes associated with secure re-employment.


RESULTS
Insecure re-employment and unemployment were associated with relative increases in minor psychiatric morbidity (mean difference 1.56 (95% confidence intervals interval 1.0 to 2.2) and 1.25 (0.6 to 2.0) respectively) and having four or more consultations with a general practitioner in the past year (odds ratio 2.04 (1.1 to 3.8) and 2.39 (1.2 to 4.7) respectively). Health outcomes for respondents permanently out of paid employment closely resembled those in secure re-employment, except for a substantial relative increase in longstanding illness (2.25; 1.1 to 4.4). Financial strain and change in psychosocial measures and health related behaviours accounted for little of the observed associations. Adjustment for change in minor psychiatric morbidity attenuated the association between insecure re-employment or unemployment and general practitioner consultations by 26% and 27%, respectively.


CONCLUSIONS
Insecure re-employment and unemployment after privatisation result in increases in minor psychiatric morbidity and consultations with a general practitioner, which are possibly due to the increased minor psychiatric morbidity.
International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London WC1E 6BT.
J E
JE
Ferrie
P
P
Martikainen
M J
MJ
Shipley
M G
MG
Marmot
S A
SA
Stansfeld
G D
GD
Smith
D000328:Adult; D004651:Employment / Q000523:psychology*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006076:Government; D015438:Health Behavior; D006305:Health Status Indicators; D006801:Humans; D008131:London; D008297:Male; D001523:Mental Disorders / Q000209:etiology*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D011332:Privatization; D011446:Prospective Studies; D014478:Unemployment / Q000523:psychology