County level socioeconomic position, work organization and depression disorder

A repeated measures cross-classified multilevel analysis of low-income nursing home workers

Carles Muntaner, Yong Li, Xiaonan Xue, Theresa Thompson, Patricia O'Campo, Haejoo Chung, William W. Eaton

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

This study simultaneously tests the effect of county, organizational, workplace, and individual level variables on depressive disorders among low-income nursing assistants employed in US nursing homes. A total of 482 observations are used from two waves of survey data collection, with an average two-year interval between initial and follow-up surveys. The overall response rate was 62 percent. The hierarchically structured data was analyzed using multilevel modeling to account for cross-classifications across levels of data. Nursing assistants working in nursing homes covered by a single union in three states were asked about aspects of their working conditions, job stress, physical and mental health status, individual and family health-care needs, household economics and household strain. Participants: The 241 nursing assistants who participated in this study were employed in 34 nursing homes and lived in 49 counties of West Virginia, Ohio and Kentucky. Main results: The study finds that emotional strain, related to providing direct care to elderly and disabled clients, is associated with depressive disorder, as is nursing home ownership type (for-profit versus not-for-profit). However, when controlling for county level socioeconomic variables (Gini index and proportion of African Americans living in the county), neither workplace nor organizational level variables were found to be statistically significant associated with depressive disorder. Conclusions: This study supports previous findings that emotional demand in health-care environments is an important correlate of mental health. It also adds empirical evidence to support a link between financial strain and depression in US women. While this study does not find that lack of a seniority wage benefits-a factor that can conceivably exacerbate financial strain over time-is associated with depressive disorder among low-income health-care workers, it does find county level measures of poverty to be statistically significant predictors of depressive disorder. Longitudinal county level measures of low-income as predictors of depression may even offer a methodological advantage in that they are presumably more stable indicators of cumulative exposure of low income than are more transient workplace indicators. Incorporating measures of cumulative exposure to low income into empirical studies would be particularly timely given the global changes that are currently restructuring the labor force and influencing work organization and labor processes-most notably the growth in low income jobs and the deskilling of labor. Though this study provides evidence that workplace and organizational level variables are associated with depressive disorder among low-wage nursing assistants in US nursing homes, the fact that these relationships do not hold once county level measures of poverty are controlled for, suggests that more distal upstream determinants of workplace mental health problems, such economic inequality, may be at play in determining the mental health of low wage workers.

Original languageEnglish
Pages (from-to)688-700
Number of pages13
JournalHealth and Place
Volume12
Issue number4
DOIs
Publication statusPublished - 2006 Dec 1
Externally publishedYes

Fingerprint

Multilevel Analysis
socioeconomic position
work organization
multi-level analysis
Depressive Disorder
nursing home
Nursing Homes
Workplace
low income
income
workplace
Depression
mental health
worker
assistant
Salaries and Fringe Benefits
Mental Health
Nursing
nursing
financial strain

Keywords

  • County level
  • Depression
  • Inequalities
  • Multilevel
  • Work organization

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health
  • Development
  • Geography, Planning and Development
  • Health(social science)

Cite this

County level socioeconomic position, work organization and depression disorder : A repeated measures cross-classified multilevel analysis of low-income nursing home workers. / Muntaner, Carles; Li, Yong; Xue, Xiaonan; Thompson, Theresa; O'Campo, Patricia; Chung, Haejoo; Eaton, William W.

In: Health and Place, Vol. 12, No. 4, 01.12.2006, p. 688-700.

Research output: Contribution to journalArticle

Muntaner, Carles ; Li, Yong ; Xue, Xiaonan ; Thompson, Theresa ; O'Campo, Patricia ; Chung, Haejoo ; Eaton, William W. / County level socioeconomic position, work organization and depression disorder : A repeated measures cross-classified multilevel analysis of low-income nursing home workers. In: Health and Place. 2006 ; Vol. 12, No. 4. pp. 688-700.
@article{0cf0a5ca52724cfebe39e741dc2f0b73,
title = "County level socioeconomic position, work organization and depression disorder: A repeated measures cross-classified multilevel analysis of low-income nursing home workers",
abstract = "This study simultaneously tests the effect of county, organizational, workplace, and individual level variables on depressive disorders among low-income nursing assistants employed in US nursing homes. A total of 482 observations are used from two waves of survey data collection, with an average two-year interval between initial and follow-up surveys. The overall response rate was 62 percent. The hierarchically structured data was analyzed using multilevel modeling to account for cross-classifications across levels of data. Nursing assistants working in nursing homes covered by a single union in three states were asked about aspects of their working conditions, job stress, physical and mental health status, individual and family health-care needs, household economics and household strain. Participants: The 241 nursing assistants who participated in this study were employed in 34 nursing homes and lived in 49 counties of West Virginia, Ohio and Kentucky. Main results: The study finds that emotional strain, related to providing direct care to elderly and disabled clients, is associated with depressive disorder, as is nursing home ownership type (for-profit versus not-for-profit). However, when controlling for county level socioeconomic variables (Gini index and proportion of African Americans living in the county), neither workplace nor organizational level variables were found to be statistically significant associated with depressive disorder. Conclusions: This study supports previous findings that emotional demand in health-care environments is an important correlate of mental health. It also adds empirical evidence to support a link between financial strain and depression in US women. While this study does not find that lack of a seniority wage benefits-a factor that can conceivably exacerbate financial strain over time-is associated with depressive disorder among low-income health-care workers, it does find county level measures of poverty to be statistically significant predictors of depressive disorder. Longitudinal county level measures of low-income as predictors of depression may even offer a methodological advantage in that they are presumably more stable indicators of cumulative exposure of low income than are more transient workplace indicators. Incorporating measures of cumulative exposure to low income into empirical studies would be particularly timely given the global changes that are currently restructuring the labor force and influencing work organization and labor processes-most notably the growth in low income jobs and the deskilling of labor. Though this study provides evidence that workplace and organizational level variables are associated with depressive disorder among low-wage nursing assistants in US nursing homes, the fact that these relationships do not hold once county level measures of poverty are controlled for, suggests that more distal upstream determinants of workplace mental health problems, such economic inequality, may be at play in determining the mental health of low wage workers.",
keywords = "County level, Depression, Inequalities, Multilevel, Work organization",
author = "Carles Muntaner and Yong Li and Xiaonan Xue and Theresa Thompson and Patricia O'Campo and Haejoo Chung and Eaton, {William W.}",
year = "2006",
month = "12",
day = "1",
doi = "10.1016/j.healthplace.2005.09.004",
language = "English",
volume = "12",
pages = "688--700",
journal = "Health and Place",
issn = "1353-8292",
publisher = "Elsevier Limited",
number = "4",

}

TY - JOUR

T1 - County level socioeconomic position, work organization and depression disorder

T2 - A repeated measures cross-classified multilevel analysis of low-income nursing home workers

AU - Muntaner, Carles

AU - Li, Yong

AU - Xue, Xiaonan

AU - Thompson, Theresa

AU - O'Campo, Patricia

AU - Chung, Haejoo

AU - Eaton, William W.

PY - 2006/12/1

Y1 - 2006/12/1

N2 - This study simultaneously tests the effect of county, organizational, workplace, and individual level variables on depressive disorders among low-income nursing assistants employed in US nursing homes. A total of 482 observations are used from two waves of survey data collection, with an average two-year interval between initial and follow-up surveys. The overall response rate was 62 percent. The hierarchically structured data was analyzed using multilevel modeling to account for cross-classifications across levels of data. Nursing assistants working in nursing homes covered by a single union in three states were asked about aspects of their working conditions, job stress, physical and mental health status, individual and family health-care needs, household economics and household strain. Participants: The 241 nursing assistants who participated in this study were employed in 34 nursing homes and lived in 49 counties of West Virginia, Ohio and Kentucky. Main results: The study finds that emotional strain, related to providing direct care to elderly and disabled clients, is associated with depressive disorder, as is nursing home ownership type (for-profit versus not-for-profit). However, when controlling for county level socioeconomic variables (Gini index and proportion of African Americans living in the county), neither workplace nor organizational level variables were found to be statistically significant associated with depressive disorder. Conclusions: This study supports previous findings that emotional demand in health-care environments is an important correlate of mental health. It also adds empirical evidence to support a link between financial strain and depression in US women. While this study does not find that lack of a seniority wage benefits-a factor that can conceivably exacerbate financial strain over time-is associated with depressive disorder among low-income health-care workers, it does find county level measures of poverty to be statistically significant predictors of depressive disorder. Longitudinal county level measures of low-income as predictors of depression may even offer a methodological advantage in that they are presumably more stable indicators of cumulative exposure of low income than are more transient workplace indicators. Incorporating measures of cumulative exposure to low income into empirical studies would be particularly timely given the global changes that are currently restructuring the labor force and influencing work organization and labor processes-most notably the growth in low income jobs and the deskilling of labor. Though this study provides evidence that workplace and organizational level variables are associated with depressive disorder among low-wage nursing assistants in US nursing homes, the fact that these relationships do not hold once county level measures of poverty are controlled for, suggests that more distal upstream determinants of workplace mental health problems, such economic inequality, may be at play in determining the mental health of low wage workers.

AB - This study simultaneously tests the effect of county, organizational, workplace, and individual level variables on depressive disorders among low-income nursing assistants employed in US nursing homes. A total of 482 observations are used from two waves of survey data collection, with an average two-year interval between initial and follow-up surveys. The overall response rate was 62 percent. The hierarchically structured data was analyzed using multilevel modeling to account for cross-classifications across levels of data. Nursing assistants working in nursing homes covered by a single union in three states were asked about aspects of their working conditions, job stress, physical and mental health status, individual and family health-care needs, household economics and household strain. Participants: The 241 nursing assistants who participated in this study were employed in 34 nursing homes and lived in 49 counties of West Virginia, Ohio and Kentucky. Main results: The study finds that emotional strain, related to providing direct care to elderly and disabled clients, is associated with depressive disorder, as is nursing home ownership type (for-profit versus not-for-profit). However, when controlling for county level socioeconomic variables (Gini index and proportion of African Americans living in the county), neither workplace nor organizational level variables were found to be statistically significant associated with depressive disorder. Conclusions: This study supports previous findings that emotional demand in health-care environments is an important correlate of mental health. It also adds empirical evidence to support a link between financial strain and depression in US women. While this study does not find that lack of a seniority wage benefits-a factor that can conceivably exacerbate financial strain over time-is associated with depressive disorder among low-income health-care workers, it does find county level measures of poverty to be statistically significant predictors of depressive disorder. Longitudinal county level measures of low-income as predictors of depression may even offer a methodological advantage in that they are presumably more stable indicators of cumulative exposure of low income than are more transient workplace indicators. Incorporating measures of cumulative exposure to low income into empirical studies would be particularly timely given the global changes that are currently restructuring the labor force and influencing work organization and labor processes-most notably the growth in low income jobs and the deskilling of labor. Though this study provides evidence that workplace and organizational level variables are associated with depressive disorder among low-wage nursing assistants in US nursing homes, the fact that these relationships do not hold once county level measures of poverty are controlled for, suggests that more distal upstream determinants of workplace mental health problems, such economic inequality, may be at play in determining the mental health of low wage workers.

KW - County level

KW - Depression

KW - Inequalities

KW - Multilevel

KW - Work organization

UR - http://www.scopus.com/inward/record.url?scp=33745443922&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33745443922&partnerID=8YFLogxK

U2 - 10.1016/j.healthplace.2005.09.004

DO - 10.1016/j.healthplace.2005.09.004

M3 - Article

VL - 12

SP - 688

EP - 700

JO - Health and Place

JF - Health and Place

SN - 1353-8292

IS - 4

ER -