title: Depressive symptoms as a cause and effect of job loss in men and women: evidence in the context of organisational downsizing from the Swedish Longitudinal Occupational Survey of Health.
abstract: BACKGROUND
  Few studies have examined depression as both a cause and effect of unemployment, but no prior work investigated these relationships in the context of organisational downsizing. We explored whether the exposure to downsizing is associated with subsequent depression (social causation), and whether pre-existing depression increases the risk of being laid off when organisations downsize (health selection).
  
  
  METHODS
  Two successive waves of the nationally representative Swedish Longitudinal Occupational Survey of Health represented the baseline (2008) and follow-up (2010) of this study. Analyses included 196 workers who lost their jobs through downsizing, 1462 layoff survivors remaining in downsized organisations and 1845 employees of non-downsized workplaces. The main outcomes were: (1) Depressive symptoms at follow-up, assessed with a brief subscale from the Symptom Checklist 90, categorised by severity levels ("major depression", "less severe symptoms" and "no depression") and analysed in relation to earlier downsizing exposure; (2) Job loss in persons with downsizing in relation to earlier depressive symptoms. The associations were assessed by means of multinomial logistic regression.
  
  
  RESULTS
  Job loss consistently predicted subsequent major depression among men and women, with a somewhat greater effect size in men. Surviving a layoff was significantly associated with subsequent major depression in women but not in men. Women with major depression have increased risks of exclusion from employment when organisations downsize, whereas job loss in men was not significantly influenced by their health.
  
  
  CONCLUSIONS
  The evidence from this study suggests that the relative importance of social causation and health selection varies by gender in the context of organisational downsizing. Strategies for handling depression among employees should be sensitive to gender-specific risks during layoffs. Policies preventing social exclusion can be important for female workers at higher risk of depression.
authors.affiliation: FG Epidemiologie, Fakultät VII, Technische Universität Berlin, Berlin, Germany. andreeva.elena@mh-hannover.de.|Centre for Applied Rehabilitation Research, Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany. andreeva.elena@mh-hannover.de.
authors.forename: Elena
authors.initials: E
authors.lastname: Andreeva
authors.affiliation: Stress Research Institute, Stockholm University, Stockholm, Sweden. linda.hanson@su.se.
authors.forename: Linda L
authors.initials: LL
authors.lastname: Magnusson Hanson
authors.affiliation: Stress Research Institute, Stockholm University, Stockholm, Sweden. hugo.westerlund@stressforskning.su.se.
authors.forename: Hugo
authors.initials: H
authors.lastname: Westerlund
authors.affiliation: Stress Research Institute, Stockholm University, Stockholm, Sweden. tores.theorell@su.se.
authors.forename: Töres
authors.initials: T
authors.lastname: Theorell
authors.affiliation: Department of Behavioral and Community Health, School of Public Health, University of North Texas Health Science Center, Fort Worth, TX, USA. harvey.brenner@unthsc.edu.|Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD, USA. harvey.brenner@unthsc.edu.
authors.forename: M Harvey
authors.initials: MH
authors.lastname: Brenner
mesh_terms: D000328:Adult; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D004651:Employment / Q000523:psychology / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D016272:Occupational Health / Q000706:statistics & numerical data*; D020415:Personnel Downsizing / Q000523:psychology / Q000706:statistics & numerical data*; D012737:Sex Factors; D011795:Surveys and Questionnaires; D013548:Sweden / Q000453:epidemiology; D014478:Unemployment / Q000523:psychology / Q000706:statistics & numerical data*; D017132:Workplace / Q000706:statistics & numerical data