Promotion

146 MENTAL HEALTH PROMOTION
access to health care and to sports and fitness facilities (WHO Regional Office for
Europe 1999).
Economic determinants
Work
There has been considerable attention to the negative mental health effects of work but
it is generally agreed that the health consequences arising from lack of work – when
this situation is involuntary – are higher (DoH 1999b). A significant part of the published
literature on work and health is derived from higher income countries. The health
impacts can result from loss of status, loss of work related social interaction and the
reduction of self-esteem. These effects can be exacerbated by poverty and other factors
which follow from job loss. An important study of the effects of a threat of job
change or job loss is the Whitehall II Study of civil servants, carried out during a
period of civil service privatization. Potential psychiatric illness increased significantly
for men both before and after change, in comparison with those in a control group
(Ferrie et al. 1995, 1998).
Box 6.3 Special issue in adulthood: work related mental health problems
In higher income countries musculoskeletal disorders followed by stress, anxiety and
depression are the leading categories of self-reported work related illness. The Bristol survey
of self-reported illness (Smith et al. 2000) estimated that about half a million people
believed they were experiencing work related stress which was making them ill and an
estimated 12.8 million working days were lost as a result. This survey did not report data for
ethnic minorities whose occupational health is under researched (University of Warwick
2004). Although figures for work related stress rose through the late 1990s they appear to
have levelled off during the last five years. In Britain certain professional groups are more
likely to report work related stress including teachers, nurses and public sector professionals
and managers. Work related stress, anxiety or depression have increased significantly in
those reporting higher workloads, tighter work deadlines, lack of support at work and
physical attacks or threats at work.
(Health and Safety Executive 2005)
Approaching retirement
While many studies have investigated the prevalence of mental health problems in
the transition years between employment and retirement (Butterworth et al. 2006),
fewer studies have considered the actual adjustment to retirement. In a British study
senior managers approaching retirement and their wives identified their hopes, fears
and expectations as ‘the general emotional quality of the relationship; the opportunity
to share time and its antithesis; the need for personal space and independence;
implications for change in the management of the household; potential bereavement
and loneliness’ (Hilbourne 1999: 172). Most concerns were related to the marriage