title: The mental health effects of multiple work and family demands. A prospective study of psychiatric sickness absence in the French GAZEL study.
abstract: BACKGROUND
  Individuals who experience work stress or heavy family demands are at elevated risk of poor mental health. Yet, the cumulative effects of multiple work and family demands are not well known, particularly in men.
  
  
  METHODS
  We studied the association between multiple work and family demands and sickness absence due to non-psychotic psychiatric disorders in a longitudinal study conducted among members of the French GAZEL cohort study (8,869 men, 2,671 women) over a period of 9 years (1995-2003). Work stress and family demands were measured by questionnaire. Medically certified psychiatric sickness absence data were obtained directly from the employer. Rate ratios (RRs) of sickness absence were calculated using Poisson regression models, adjusting for age, marital status, social support, stressful life events, alcohol consumption, body mass and depressive symptoms at baseline.
  
  
  RESULTS
  Participants simultaneously exposed to high levels of work and family demands (> or =2 work stress factors and > or =4 dependents) had significantly higher rates of sickness absence due to non-psychotic psychiatric disorders than participants with lower levels of demands (compared to participants exposed to 0-1 work stress factors and with 1-3 dependents, age-adjusted rate ratios were 2.37 (95% CI 1.02-5.52) in men and 6.36 (95% CI 3.38-11.94) in women. After adjusting for baseline socio-demographic, behavioral and health characteristics, these RRs were respectively reduced to 1.82 (95% CI 0.86-3.87) in men, 5.04 (95% CI 2.84-8.90) in women. The effect of multiple work and family demands was strongest for sickness absence due to depression: age-adjusted RRs among participants with the highest level of work and family demands were 4.70 (1.96-11.24) in men, 8.57 (4.26-17.22) in women; fully adjusted RRs: 3.55 (95% CI 1.62-7.77) in men, 6.58 (95%CI 3.46-12.50) in women.
  
  
  CONCLUSIONS
  Men and women simultaneously exposed to high levels of work stress and family demands are at high risk of experiencing mental health problems, particularly depression.
authors.affiliation: MRC Centre for Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, King's College, London, UK. maria.melchior@st-maurice.inserm.fr
authors.forename: Maria
authors.initials: M
authors.lastname: Melchior
authors.forename: Lisa F
authors.initials: LF
authors.lastname: Berkman
authors.forename: Isabelle
authors.initials: I
authors.lastname: Niedhammer
authors.forename: Marie
authors.initials: M
authors.lastname: Zins
authors.forename: Marcel
authors.initials: M
authors.lastname: Goldberg
mesh_terms: D000328:Adult; D015331:Cohort Studies; D004651:Employment / Q000523:psychology* / Q000706:statistics & numerical data; D005190:Family / Q000523:psychology*; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000523:psychology; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D017678:Sex Distribution; D012944:Social Support; D012959:Socioeconomic Factors; D013315:Stress, Psychological / Q000453:epidemiology / Q000523:psychology*; D011795:Surveys and Questionnaires; D016526:Workload / Q000523:psychology / Q000706:statistics & numerical data