Research report
The association of social support at work and in private life with mental health and antidepressant use: The Health 2000 Study

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Abstract

Background

Social support is assumed to protect mental health, but it is not known whether low social support at work increases the risk of common mental disorders or antidepressant medication. This study, carried out in Finland 2000–2003, examined the associations of low social support at work and in private life with DSM-IV depressive and anxiety disorders and subsequent antidepressant medication.

Methods

Social support was measured with self-assessment scales in a cohort of 3429 employees from a population-based health survey. A 12-month prevalence of depressive or anxiety disorders was examined with the Composite International Diagnostic Interview (CIDI), which encompasses operationalized criteria for DSM-IV diagnoses and allows the estimation of DSM-IV diagnoses for major mental disorders. Purchases of antidepressants in a 3-year follow-up were collected from the nationwide pharmaceutical register of the Social Insurance Institution.

Results

Low social support at work and in private life was associated with a 12-month prevalence of depressive or anxiety disorders (adjusted odds ratio 2.02, 95% CI 1.48–2.82 for supervisory support, 1.65, 95% CI 1.05–2.59 for colleague support, and 1.62, 95% CI 1.12–2.36 for private life support). Work-related social support was also associated with subsequent antidepressant use.

Limitations

This study used a cross-sectional analysis of DSM-IV mental disorders. The use of purchases of antidepressant as an indicator of depressive and anxiety disorders can result in an underestimation of the actual mental disorders.

Conclusions

Low social support, both at work and in private life, is associated with DSM-IV mental disorders, and low social support at work is also a risk factor for mental disorders treated with antidepressant medication.

Introduction

Mental disorders, and in particular depression, are quite common in general and working populations (Järvisalo et al., 2005, Alonso et al., 2004, Bijl et al., 1998, De Graaf et al., 2002, Ohayon and Schatzberg, 2002). In Finland, for example, the prevalence of depressive disorders is 6.4% (employees) to 11.9% (unemployed) among the working age population (Honkonen et al., 2007). Depressive disorders are one of the most significant contributors to work disability (Rytsälä et al., 2005, Murray and Lopez, 1997) and premature exit from the labour market (Kuusisto and Varisto, 2005, Gould and Nyman, 2004). Although the prevalence of mental disorders has not increased in Finland (Pirkola et al., 2005), there is an increasing trend towards sick leaves due to mental disorders and the use of antidepressants has increased 7-fold from 1990 to 2005 (Klaukka, 2006, Finnish Statistics on Medicines 2005, 2006).

Social support has been shown to associate with mental health (Bromet et al., 1992, Escriba-Aguir and Tenias-Burillo, 2004, Fujita and Kanaoka, 2003, Kawakami et al., 1992, Park et al., 2004, Plaisier et al., 2007, Stansfeld et al., 1999, Watanabe et al., 2004). Studies suggest that social support reduces job stress (Oginska-Bulik, 2005), increases job satisfaction (McCalister et al., 2006), protects against insomnia (Nakata et al., 2004, Nakata et al., 2001) and is associated with a reduced incidence of depressive and anxiety disorders (Plaisier et al., 2007). Social support has been found to be a kind of a buffer against the stressors of the work environment (Cooper, 1998). In some studies the buffer hypotheses were refuted (Sanne et al., 2005, Ganster et al., 1986). However, social relationships can also be negative or have conflicting aspects (House et al., 1988). The problems in the atmosphere of the social environment of a work community have been shown to predict self-reported depression (Ylipaavalniemi et al., 2005) and sick leaves (Väänänen, 2005, Väänänen et al., 2004, Väänänen et al., 2003). In many studies there is evidence that low levels of social support increase the risk of mental symptoms (Stansfeld et al., 1997, Niedhammer et al., 1998, Paterniti et al., 2002, Stansfeld et al., 1999). Unfairness in leadership has been identified to be associated with the reduced mental health of employees (Elovainio et al., 2002, Kivimäki et al., 2003). Severe problems in social relationships at work, such as bullying, can increase the risk of depression (Kivimäki et al., 2003, Vartia-Väänänen, 2003).

According to several studies, women are twice as likely to suffer from depressive or anxiety disorders as men (Alonso et al., 2004, Plaisier et al., 2007). Gender differences in social support tend to suggest that women both give and receive more support than men (Beehr et al., 2003, Fuhrer et al., 1999) but the favourable effect of support is stronger for men than for women (Fuhrer and Stansfeld, 2002, Plaisier et al., 2007, Schwarzer, 2005, Väänänen et al., 2005). One study found that women but not men with low supervisor support were at increased risk for severe depressive symptoms whereas no association was observed between support from colleagues and severe depressive symptoms in either gender (Rugulies et al., 2006). Partner or family strain more often seems to be predictive of ill-health outcomes for women (Walen and Lachman, 2000).

Reliance on self-estimation of depression and anxiety disorders in selected populations is a major limitation of most previous social support studies and for this reason it is not clear to what extent the existing evidence can be extrapolated to the general population. Using the population-based data of the nationwide Health 2000 study, we examined mental health in a cohort of employees with a standardized psychiatric interview (CIDI) and followed their recorded purchases of prescribed antidepressants during a 3-year period. To our knowledge this is the first study to compare the significance of social support at work with private life support in psychiatric disorders by using the CIDI. This is also the first study to examine whether low social support predicts antidepressant medication.

Section snippets

Study sample

The Health 2000 Study was a nationally representative population-based health study carried out in Finland 2000–2001. The two-stage stratified cluster sample comprised the Finnish population (0.24% sample) aged 30 years or over and included 8028 persons (Statistical Yearbook of , 2000, Aromaa and Koskinen, 2004). The frame was regionally stratified according to the five university hospital districts, each serving about one million inhabitants and differing in several features related to health

Results

The characteristics of the study participants by gender are shown in Table 1. Women had higher occupational grade and were more likely to be divorced, widowed or single than men. A greater proportion of women than men also reported lifetime mental disorders and had a higher prevalence of 12-month mental disorders. A greater proportion of women than men had both depressive and anxiety disorders and also used antidepressants during the follow-up-period more often. Women reported getting more

Discussion

Evidence from a population-based cohort of 3429 Finnish men and women suggest that low social support both at work and in private life is associated with DSM-IV diagnoses of depressive or anxiety disorders. Low social support at work unlike in private life also predicted subsequent antidepressant medication. These findings are in accordance with some earlier studies showing an association between low social support and mental health problems (Plaisier et al., 2007, Stansfeld et al., 1999,

Role of funding source

MS is supported by the Social Insurance Institution of Finland.

Conflict of interest

None.

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