title: Health and unemployment: 14 years of follow-up on job loss in the Norwegian HUNT Study.
abstract: BACKGROUND
  Many studies have investigated how unemployment influences health, less attention has been paid to the reverse causal direction; how health may influence the risk of becoming unemployed. We prospectively investigated a wide range of health measures and subsequent risk of unemployment during 14 years of follow-up.
  
  
  METHODS
  Self-reported health data from 36 249 participants in the Norwegian HUNT2 Study (1995-1997) was linked by a personal identification number to the National Insurance Database (1992-2008). Exact dates of unemployment were available. Cox's proportional hazard models were used to estimate hazard ratios (HR) for the association of unemployment with several health measures. Adjustment variables were age, gender, education, marital status, occupation, lifestyle and previous unemployment.
  
  
  RESULTS
  Compared to reporting no conditions/symptoms, having ≥3 chronic somatic conditions (HR 1.78, 95% CI 1.46-2.17) or high symptom levels of anxiety and depression (HR 1.57, 95% CI 1.35-1.83) increased the risk of subsequent unemployment substantially. Poor self-rated health (HR 1.36, 95% CI 1.24-1.51), insomnia (HR 1.19, 95% CI 1.09-1.32), gastrointestinal symptoms (HR 1.17, 95% CI 1.08-1.26), high alcohol consumption (HR 1.17, 95% CI 0.95-1.44) and problematic use of alcohol measured by the CAGE questionnaire (HR 1.32, 95% CI 1.17-1.48) were also associated with increased risk of unemployment.
  
  
  CONCLUSIONS
  People with poor mental and physical health are at increased risk of job loss. This contributes to poor health amongst the unemployed and highlights the need for policy focus on the health and welfare of out of work individuals, including support preparing them for re-employment.
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Department of Health, SINTEF Technology and Society, Trondheim, Norway silje.kaspersen@ntnu.no.
authors.forename: Silje L
authors.initials: SL
authors.lastname: Kaspersen
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Kristine
authors.initials: K
authors.lastname: Pape
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Gunnhild Å
authors.initials: GÅ
authors.lastname: Vie
authors.affiliation: Department of Health, SINTEF Technology and Society, Trondheim, Norway.
authors.forename: Solveig O
authors.initials: SO
authors.lastname: Ose
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Psychiatric Department, Levanger Hospital, Nord-Trøndelag Health Trust, Norway.
authors.forename: Steinar
authors.initials: S
authors.lastname: Krokstad
authors.affiliation: School of Social and Community Medicine, University of Bristol, Bristol, England.
authors.forename: David
authors.initials: D
authors.lastname: Gunnell
authors.affiliation: Department of Public Health and General Practice, Norwegian University of Science and Technology, Trondheim, Norway Forensic Department and Research Centre Bröset, St. Olav's University Hospital Trondheim, Trondheim, Norway.
authors.forename: Johan H
authors.initials: JH
authors.lastname: Bjørngaard
mesh_terms: D000328:Adult; D000368:Aged; D000428:Alcohol Drinking / Q000453:epidemiology; D004651:Employment / Q000706:statistics & numerical data*; D005260:Female; D005767:Gastrointestinal Diseases / Q000453:epidemiology; D006304:Health Status; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data; D008875:Middle Aged; D009664:Norway; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology; D012959:Socioeconomic Factors; D014478:Unemployment / Q000706:statistics & numerical data*