Exploring the possible health consequences of job insecurity: a pilot study among young workers

Original

article

Exploring

the

possible

health

consequences

of

job

insecurity:

a

pilot

study

among

young

workers

Fabrizio

Bert,

Maria

Rosaria

Gualano,

Robin

Thomas,

Guglielmo

Vergnano,

Gianluca

Voglino

∗

_,

_Roberta

_Siliquini

DepartmentofPublicHealth,UniversityofTorino,Torino,Italy

a

r

t

i

c

l

e

i

n

f

o

Articlehistory: Received5June2018 Accepted27August2018 Availableonlinexxx Keywords: Depressivedisorders Anxietydisorders Alcoholdrinking Substance-relateddisorders Employment

a

b

s

t

r

a

c

t

Objective:Socio-economicalchangesinEuropeareleadingtotheriseofnewissuesregardingthelabour marketandhealthofyoungworkers.Jobinsecurityisawidelystudiedphenomenonthatinvolvesan increasingnumberofyoungworkers.Weinvestigateditsassociationwithmentalhealthandhazardous behaviours.

Method:Inthispilotstudy,504subjectsagedbetween18and40wereinterviewed.STROBEguidelines wereused.Socio-economicfactorswereevaluated.Adaptedformsofvalidatedscaleswereusedtoassess depression,anxietydisorder,alcoholanddrugabuseandsmokinghabit.Univariateandmultivariate analyseswereperformed.

Results:Jobinsecurityappearedtobepartiallyconnectedwiththetypeofemployment.Mostrespondents withapermanentcontractfelttheirsituationwassecure,whilethisproportionwasreducedwhen referringtotemporaryjobsandotherkindsofcontract(p<0.001).Jobsecurityperceptionwasassociated withdepression,anxiety,alcoholabuseandsmokinghabit(p<0.001).

Conclusions:Jobsecurityperceptionappearstobethemostimportantpredictivefactorforthepresence ofdepressionandanxietysymptoms,alcoholconsumptionandsmokinghabitcomparedtoother socio-economicfactorsunderstudy.

©2018SESPAS.PublishedbyElsevierEspa˜na,S.L.U.ThisisanopenaccessarticleundertheCC BY-NC-NDlicense(http://creativecommons.org/licenses/by-nc-nd/4.0/).

Las

posibles

consecuencias

de

la

inseguridad

laboral

para

la

salud:

estudio

piloto

entre

jóvenes

trabajadores

Palabrasclave: Depresión Trastornodeansiedad Consumodealcohol Abusodesustancias Inseguridadlaboral

r

e

s

u

m

e

n

Objetivo:LoscambiossocioeconómicosenEuropaestánprovocandoelsurgimientodenuevascuestiones sobrelasaluddelostrabajadoresjóvenes.Lainseguridadlaboralesunfenómenoqueinvolucrauna cantidadcrecientedetrabajadoresjóvenes.Nuestroestudiotienecomoobjetivoinvestigarlaasociación entreinseguridadlaboralysaludmentalycomportamientospeligrosos.

Método: Enesteestudiopilotofueronentrevistados504sujetosconedadescomprendidasentre18y 40a˜nos.Seevaluaronlosfactoressocioeconómicos.Seusaronformasadaptadasdeescalasvalidadas paraevaluarladepresión,laansiedad,elabusodealcoholydrogas,yelhábitodefumar.Serealizaron análisisunivariadosymultivariados.

Resultados: Lamayoríadelosencuestadosconcontratopermanenteconsideróquesusituaciónera segura,mientrasqueestaproporciónseredujoalreferirseatrabajostemporalesyotrostiposdecontrato (p<0,001).Lapercepcióndelaseguridadlaboralseasocióconladepresión,laansiedad,elabusodealcohol yelhábitodefumar(p<0,001).

Conclusiones:Lapercepcióndelaseguridadlaboralpareceserelfactorpredictivomásimportantepara lapresenciadesíntomasdedepresiónyansiedad,elconsumodealcoholyelhábitodefumar,en comparaciónconotrosfactoressocioeconómicosenestudio.

©2018SESPAS.PublicadoporElsevierEspa˜na,S.L.U.Esteesunart´ıculoOpenAccessbajolalicencia CCBY-NC-ND(http://creativecommons.org/licenses/by-nc-nd/4.0/).

∗ Correspondingauthor.

E-mailaddress:gianluca.voglino@unito.it(G.Voglino).

Introduction

Inthelastdecades,socialandeconomicalchangesinWestern Countriescauseddeepchangesinthelabourmarket.Particularly, unemploymentandflexibilityhavegrown,leadingtothenew con-ceptofjobinsecurity.1_{Inparticular,jobinsecurityisdefinedas“the}

https://doi.org/10.1016/j.gaceta.2018.08.011

0213-9111/©2018SESPAS.PublishedbyElsevierEspa˜na,S.L.U.ThisisanopenaccessarticleundertheCCBY-NC-NDlicense(

WithintheEuropeanUnion(EU),thenumberofemployed peo-ple is still lower than it used to be before the 2008 crisis by 2.2millionworkers.3_{Specifically,talkingabouttheItalian}

situa-tion,theoccupationalrateshowsanoverallfallof2.3%in2008, whereastheoccupationalrateamongtheyouthpopulation(15-34 yearsold)isstill16.5%belowtheEUaveragerate.3_{Datadescribea}

growthofshort-termworkerswithinthetotalemployed popula-tionintheEU,increasingfrom17.5%to19.6%,between2008and 2015.3_{Moreover,about50%ofshort-termcontractslastlessthan}

oneyearandonly20%ofthemlastatleast12months.3_Thistrendis

morecommonamongtheyoungworkerspopulation.Among work-ersaged20to24,therateofshort-termemployeeshasrisenfrom 19.4%to45.6%amongthemenpopulationandfrom26.1%to49.5% amongwomen.Wecanalsoseeanincreaseformenandwomen aged25to29and30to34yearsold.3

Theroleplayedbyoccupationasahealthdeterminantiswell known,buttheneedofabettercomprehensionofthejobinsecurity hasalsoemerged.Manystudiesassessedthespatialandtemporal work’sflexibilityimpactonhealth.However,theevidenceonthis possibleassociationisnotconsistent.Ameta-analysis consider-ing27studies4_{hasdemonstratedtheexistenceofanassociation}

betweenshort-termjobsandpoormentalhealth.Thisassociation seemstobestrongerwhentheinsecuritygrows,anditchanges accordingtogenderandsocialbackground.Therearealsoother studieswhichnotonlyunderlinetheassociationsbetween short-termcontractsandpoorpsychologicaloutcomes,butdoalsoprove acausalconnectionbetweenthem.5–8_{Atthesametimethe}

liter-aturepresentavarietyofresults9–11_{thatcouldberelatedtothe}

varietyofoutcomesassessedinthesepapers.Otherstudiesshow howlowerincome,12_{reducedaccesstobenefitsandpoorerfuture}

perspectives13–15_orgender16_{canaffecttheassociation.Theresults}

arenoteasilygeneralized,becauseeachcountryhasitsown wel-faresystem,providingdifferentplansofassistancetoitscitizens.In lightofthis,itseemstobeclearthatjobinsecurityneedstobe bet-terassessedasasocialdeterminantofhealth.Ourresearchaimed toexplorethejobinsecurityasapossibleriskfactorforpoormental health,alcoholanddrugsabuseandsmokinghabitintheSouthern Europecontext.Thispilotstudywasusedtoidentifythekeypoints andpossiblyrelevantaspectsthatcanhelpthisassessment. Method

Theteamperformedacross-sectionalpilotstudyinthecityof Torino,Italy.STROBEguidelineforobservationalstudieswasused forreporting.17_{Theparticipants(18-40yearsold)wereenrolledby}

usingaconveniencesample,recruitedinpublicrecreationalareas, likeconcertsclubandbars,betweenAprilandJune2016.The par-ticipantswereinformedaboutthestudyandsignedtheinformed consent.Tworesearchersperformeddirect personalinterviews. Eachinterviewlastedaround20minutes.DifferentItalian trans-lated evaluation scales were used to evaluate the presence of mentalhealthproblems,drugandalcoholabuseandtobacco addic-tion.

Samplesizecalculation

Thesamplesizehasbeendefined accordingtodemographic dataforpopulationagedbetween18and40livinginTorino.18_The

totalnumberofpeoplewhofitsthesecharacteristicsis224.767. Oursamplesizewascalculatedusingboththeexpectedfrequency

tobeconservative,weplannedtoenrol500subjects.Thesample sizehasbeencalculatedusingEpiInfosoftware.

Questionnairesandscales

Thequestionnairewascomposedofsixtymultiple-choice ques-tions.Thefirstfifteenquestionsassessedsocio-economicfactors (gender,age,nationality,familystatusandstructure,educational level, occupationalstatus and perceptionand income level and perception). In particular, question11 asked whetherthe sub-jectperceivedhisownoccupational statusasverysecure,quite secure,quiteinsecureorveryinsecure.Duringtheanalysesprocess thisvariablewererecordedin“secure”forquitesecureandvery secureanswers,andin“insecure”forveryinsecureandquite inse-cureanswers.Theotherquestionswereusedtoscreenandassess clinicalhealthoutcomesandsubstancesconsumptionhabits.The Italiantranslatedversionsofthefollowingvalidatedscaleswere used; thePatientHealth Questionnaire-9is a self-administered questionnaire used for screening purposes towards depression symptoms,19_{accordingtoDSM-IV cut-offs.}20_Toassessthe

anx-ietysymptoms theGeneralized Anxiety Disorder-7wasused.21

ThealcoholconsumptionwasscreenedwiththeAlcoholUse Dis-orderIdentificationTest(AUDIT),developed bytheWHO.22_The

DrugAbuseScreeningTest(DAST-10)wasusedtoassessthe pres-enceandseverityofdrugsconsumption/abuse.23_{Toscreennicotine}

addiction,thesampleansweredtotheFagerstromTestforNicotine Dependence.24_{Questionnaireswereadministeredafterdelivering}

informationaboutprivacytermsandconditions.Further informa-tionwere providedwhen necessary. Finally,the questionnaires werecompletedensuringtheproperprivacy,whiletheinformation wasstoredanonymously.

Statisticalanalysis

ThestatisticalanalysiswasconductedwithSTATAMP13 soft-ware(StataCorp.,CollegeStation,TX,2013).Adescriptiveanalysis wasconducted. Frequenciesand percentagesof the categorical variables were reported. The sample was stratified for gender, perceivedjobsecurityandoccupationalstatus,performinga uni-variateanalysis.Toassesspredictorsofdepression,anxiety,alcohol consumption,illegalsubstancesusageandsmokinghabit,a multi-variateregressionanalysiswasconductedusingastepwiseforward approach throughout five different models of ordered logistic regression.25 _{The included independent variables were gender,}

age,nationality,familiarstatus,occupationalstatus,jobsecurity perception,salaryperception,presenceofcongenitalpathologies andstudytitle.Theincludedindependentvariableswereselected considering the main risk factors for poor mental health and riskybehaviourspointedoutbythescientificliterature.5–13,16,26–35

Finally,theresultswerereportedasOddsRatiosvalueswiththeir related95%confidenceintervalsandp-values.Alltheresultswere consideredstatisticallysignificantwhenthep-value wasbelow 0.05.

Results

Thefinalsamplesizeforthepilotstudyconsistedof504 sub-jects.In Table1 themain demographic,occupationaland social featuresofthesampleareresumedstratifiedbygenderand per-ceptionofjobsecurity.Datashowhowtheworkerswhoperceive theirjobsituationasinsecurearemoreoftenunmarried(69.2%vs.

this article in press as: Bert F, et al. Exploring the possible health consequences of job insecurity: a pilot study among young Gac Sanit. 2018. https://doi.org/10.1016/j.gaceta.2018.08.011

AR

TICLE IN PRESS

No. of Pages 8 F. Bert et al. / Gac Sanit. 2018; xxx(xx) :xxx–xxx Table1

Socio-demographicdatastratifiedbygenderandjobsecurityperception.

Gender Jobsecurityperception

Male Female p Secure Insecure p

% N % N % N % N

Gender Male - - - 48.1 103 44 70 0.432

Female - - - 51.9 111 56 89

Nationality Italian 97.5 230 95.5 256 0.243 94.9 203 98.1 156 0.1

Other 2.5 6 4.5 12 5.1 11 1.9 3

Familystatus Single 71.5 168 64.5 173 0.3 50.9 109 69.2 110 <0.001

Cohabitant 14.5 34 20.2 54 22.5 48 21.4 34

Married 13.2 31 13.8 37 23.8 51 9.4 15

Divorced 0.8 2 1.5 4 2.8 6 0 0

Familystructure Livingwithparents 39.4 93 31.9 85 0.203 18.2 39 27.2 43 <0.001

Livingalone+economicallydependentonparents 11.4 27 13.1 35 3.8 8 15.8 25

Livingalone+economicallyindependent 39.4 93 46.4 124 61.2 131 51.9 82

Economicallyindependent+someonedependsonme 9.8 23 8.6 23 16.8 36 5.1 8

Educational qualification None 0.4 1 0 0 <0.001 0.5 1 0 0 0.45 MiddleSchool 6.4 15 2.6 7 5.2 11 3.1 5 HighSchool 49.6 117 40.8 109 31.4 67 37.1 59 University 43.6 103 56.6 151 62.9 134 59.8 95

Worker Permanentcontract,temporaryjoborothertypeofcontract 70.6 166 71.3 191 0.877 . . . . .

Notworker Studentandunemployed 29.4 69 28.7 77 . . . . .

Jobsecurity perception

Secureorquitesecure 59.5 103 55.5 111 0.432 . . . . .

Insecureorquiteinsecure 40.5 70 44.5 89 . . . . .

Familyincome Lessthan10.000euros/year 8.2 17 9.4 22 0.848 4.9 10 15.8 23 <0.001

Between10.000and20.000euros/year 23.5 49 26.4 62 21.2 43 32.2 47

Between20.000and40.000euros/year 42.3 88 42.5 100 50.7 103 34.9 51

Between40.000and60.000euros/year 15.4 32 12.8 30 15.8 32 10.3 15

Morethan60.000euros/year 10.6 22 8.9 21 7.4 15 6.8 10

Personalincome Lessthan10.000euros/year 45.3 87 45.5 96 0.145 24.5 51 61 94 <0.001

Between10.000and20.000euros/year 28.7 55 35.6 75 38.5 80 30.5 47

Between20.000and40.000euros/year 21.9 42 18 38 33.6 70 6.5 10

Between40.000and60.000euros/year 3.1 6 0.9 2 2.9 6 1.3 2

Morethan60.000euros/year 1 2 0 0 0.5 1 0.7 1

Incomeperception Unsatisfactory 5.3 12 3.5 9 0.809 1.4 3 5.0 8 <0.001

Poor 24.1 55 23.9 62 18.6 39 39.0 62

Adequate 63.6 145 65.3 169 72.4 152 51.6 82

Jobsecurityperception Secure Insecure p % N % N Occupational status Permanentcontract 91.3 105 8.7 10 <0.001 Temporaryjob 45.6 47 54.4 56

Othertypeofcontract 41.7 60 58.3 84

<0.001)ordostillrelyeconomicallyonthem,evenwhenlivingon theirown(15.8%vs.3.8%;p<0.001).Ontheotherhand,alarger proportionofsecureworkerslivesonitsownandisnotonlymore frequentlyeconomicallyindependent(61.2%vs.51.9%;p<0.001), butitalsoappearstosharemoreoftenpartofitsincomewith par-entsand/orrelatives(16.8%vs.5.1%;p<0.001).Thesedifferences maybepartiallyexplainedwiththedifferenceinmeanage.The meanageinthesecuregroupis 30,05±5,23 yearswhileinthe insecuregroupis28,01±4,56years(p<0.001).Whileno statisti-callysignificantdifferencesareshownbetweensecureandinsecure workersonthebasisoftheireducationalqualification,relevant dif-ferencesappeartoexistamongthedifferentkindofjobcontractin thesample.Analysingtheassociationbetweenfamiliarand indi-vidualannualincomegroupsand theperceptionofjobsecurity orinsecurity,Table1showsthatbothgroupsfeeltheirsituation asinsecure.Byassessingtheassociationbetweentheperception ofpersonalincomeandjobsecurity,itemergedthatworkerswho describethemselvessecurearemorelikelytoconsidertheirincome adequate(72.4%vs.51.57%;p<0.001)orexcellent(7,6%vs.4.4%;p <0.001),while,ontheotherside,perceivedjobinsecuritymaylead toconsidertheincomeasunsatisfactory(5%vs.1.4%;p<0.001)or poor(39%vs.18.6%;p<0.001).

Table2describeshowthelargemajorityofthosewhohavea permanentcontractfeeltheirsituationassecure,whilethis pro-portionisreducedbyaboutitshalfwhenreferringtotemporary jobsandotherkindsofcontract(p<0.001).

Table3showsthemaindifferencesregardingmentalproblems’ andsubstancesconsumption’sprevalencebetweenthemaleand thefemale population. Astatistically significanthigher propor-tionofanxietydisturbanceisrecordedinthefemalepopulation (30.8%showmildanxiety,10.2%moderateanxietyand4.1%severe generalizedanxietydisorder,versus23.8%,4.7%and1.7% respec-tivelyforthemalepopulation;p<0.001).Ontheotherside,the malepopulationappearstobestatisticallysignificantmorerelated towardshazardousalcoholconsumption(17.9%vs.7.9%;p<0.001). Thesamestatisticallysignificantresultsareshownfordrugsabuse (p=0.043).

Theperceivedjobsecurityamongtheworkersinterviewedin thisstudyseemstobealsorelatedtomentaldisturbancesand sub-stancesuseand/orabuse:secureworkersshowedlessdepression symptomsthaninsecureworkers(p<0.001)asreportedinTable3. Thesamepatternisnoticeableforthepresenceofanxiety-related symptoms(p<0.001).Forwhatitconcernsalcoholconsumption andtobaccoaddiction,wecanstillfindapreponderanceamong insecureworkersratherthansecure(p<0.001).

Multivariateanalysis

Table4identifies,throughanorderedlogisticregression,the presenceofpotentialpredictorsrelatedtotheclinicaloutcomes assessed.Firstly,itisnoticeablehowthefemalegenderappears tobeapredictorofdepression(oddsratio[OR]:1.88;95%

con-depressive symptoms(OR:0.41; 95%CI:0.23-0.73; p=0.002for dependentswholivealone;OR:0.40;95%CI:0.20-0.79;p=0.008 forindependentslivingalone).Anotherimportantpositive predic-torofdepressivedisturbancesistheperceptionofjobinsecurity (OR:4.64;95%CI:2.90-7.43;p<0.001),whilethepresenceofan adequate(OR:0.18;95%CI:0.05-0.65;p=0.009)orofahighincome (OR:0.05;95%CI:0.01-0.26;p<0.001)maybeastrongnegative factorstowardsthedevelopmentofdepressivesymptoms. Coher-ently,theanalysesshowthatthesamepredictorswhichintervene indepressiveoutcomesarepresentforanxietyoutcomes(female genderOR:2.17;95%CI:1.36-3.44,p=0.001;livingalonebut rely-ingeconomicallyonparentsOR:0.51;95%CI:0.29-0.92;p=0.04;to beeconomicallyindependentOR:0.46;95%CI:0.22-0.96;p=0.04). Theperceptionofjobinsecurityisagainapotentialpositive pre-dictorforanxiety(OR:2.55;95%CI:1.58-4.12;p<0.001).Presence ofanadequateincomeseemstobeanegativepredictorforanxiety (OR:0.21;95%CI:0.06-0.77;p=0.02),justasthepresenceofahigh income(OR:0.09;95%CI:0.02-0.51;p=0.006).

Femalegenderisalsoshownasastatisticallysignificant poten-tialnegativepredictorinreferencetoalcoholconsumption (OR: 0.26;95%CI:0.14-0.51;p<0.001),justaseconomicalindependence (OR:0.04;95%CI:0.01-0.37;p=0.004)andthepresenceofan ade-quatesalary(OR:0.22;95%CI:0.5-0.94;p=0.04).Ontheopposite side,theperceptionofjobinsecurityappearstobeapositive predic-torforalcoholuseorabuse(OR:2.75;95%CI:1.40-5.39;p=0.003). Femalegenderalso appearstobea negativepredictortowards drugsabuse(OR:0.49;95%CI:0.31-0.78;p=0.003).

Referringtosmokinghabitandtobaccoaddiction,thefemale genderisagainastatisticallysignificantpotentialnegative predic-tor(OR:0.64;95%CI:0.42-0.99;p=0.04),togetherwitheconomical independence(OR:0.35;95%CI:0.17-0.70;p=0.003).The percep-tionofjobinsecurityisinsteadapotentialpositivepredictorfor smokinghabit(OR:2.38;95%CI:1.50-3.78;p<0.001).

Discussion

The associationbetween unemployment and mental distur-bances in the young population has been widely investigated, especiallyduringthelastdecade,sincetheworldwidefinancial cri-sisstartedtodisplayitsinfluenceonsociety.Theincreaseofmental illnesses’ incidence among the unemployed young population appearstobeacommontrendinallEuropeancountries.26_Other

studiesconductedinSouthernEuropecountrieshavenotonly con-firmedthistrend,buthavealsopointedoutamajorassociation betweenunemployment and mood disorders, particularly with depressionandanxiety.27–29_{Moreover,similarresultswerefound}

inothernon-Europeancountries,suggestingapossibleimportant roleofthecrisisintheinfluenceoflabourmarketchangesandon relatedhealthissuesacrosstheworld.30,31_{Accordingtoour}

prelim-inaryresults,theperceptionofjobinsecurityappearstoberelated notonlytomentaldisturbances,butalsotohazardousbehaviours. Thesefindingsareconfirmedinliterature.32,33_{In particular,one}

this article in press as: Bert F, et al. Exploring the possible health consequences of job insecurity: a pilot study among young Gac Sanit. 2018. https://doi.org/10.1016/j.gaceta.2018.08.011

AR

TICLE IN PRESS

No. of Pages 8 F. Bert et al. / Gac Sanit. 2018; xxx(xx) :xxx–xxx Table3

Mentalhealthandhazardoushabitsoutcomestratifiedbygenderandjobsecurityperception.

Gender JobsecurityPerception

Male Female p Secure Insecure p

% N % N % N % N

Depression (Phq-9)

Nosymptoms 50.9 120 40.3 108 0.075 64.5 138 23.9 38 <0.001

Minimalsymptoms 37.7 89 40.7 109 29.4 63 54.1 86

Minordepression/majordepression,mild 8.9 21 13.4 36 4.7 10 13.2 21

Majordepression,moderate 2.1 5 4.5 12 0.9 2 7.5 12

Majordepression,severe 0.4 1 1.1 3 0.5 1 1.3 2

Anxiety (GAD-7) Nosymptoms 69.8 164 54.9 146 <0.001 74.4 157 47.8 76 <0.001 Mildanxiety 23.8 56 30.8 82 20.9 44 35.8 57 Moderateanxiety 4.7 11 10.2 27 3.8 8 10.7 17 Severeanxiety 1.7 4 4.1 11 0.9 2 5.7 9 Alcohol consumption (AUDIT)

Noconsumptionormildconsumption 80 188 90.6 242 <0.001 90.7 194 75.5 120 <0.001

Hazardousconsumption 17.9 42 7.9 21 7.9 17 22.6 36 Alcoholabuse 2.1 5 1.5 4 1.4 3 1.9 3 Drugabuse (Dast-10) Noconsumption 64.8 153 76.2 202 0.043 72.4 155 63.9 101 0.09 Lowlevel 28.4 67 20 53 23.4 50 28.5 45 Moderatelevel 5.9 14 3.4 9 4.2 9 5.7 9 Severelevel 0.9 2 0.4 1 0 0 1.9 3 Smokinghabit (FagerstromTest) Nonsmoker 47.7 112 56.9 152 0.068 58.7 125 37.1 59 <0.001

Smokernotnicotineaddicted 48.1 113 37.8 101 38.5 82 54.1 86

in press as: Bert F, et al. Exploring the possible health consequences of job insecurity: a pilot study among 2018. https://doi.org/10.1016/j.gaceta.2018.08.011

AR

TICLE IN PRESS

Pages 8 F. Bert et al. / Gac Sanit. 2018; xxx(xx) :xxx–xxx Table4

Orderedmultivariateanalysis(includinggender,age,nationality,familystructure,educationalqualification,occupation,jobsecurityperception,incomeperceptionandcongenitaldisorder). Depression (Phq-9) Anxiety (GAD-7) Alcoholconsumption (AUDIT) Drugabuse (Dast-10) Smokinghabit (FagerstromTest)

aOR CI95% aOR CI95% aOR CI95% aOR CI95% aOR CI95%

Gender Male 1 - 1 - 1 - 1 - 1

-Female 1.88a _{1.22-2.90 2.17}a _{1.36-3.44 0.26}a _{0.14-0.51 0.49}a _{0.31-0.78 0.64}a _0.42-0.99

Age 1.01 0.95-1.05 1.01 0.95-1.05 1.03 0.96-1.12 1.02 0.97-1.08 1.03 0.98-1.09

Nationality Italian 1 - 1 - 1 - 1 - 1

-Other 1.19 0.36-3.98 0.73 0.22-2.48 0.31 0.04-2.52 1.13 0.28-4.63 1.21 0.36-4.07

Familystructure Livingwithparents 1 - 1 - 1 - 1 - 1

-Livingalone+economicallydependentonparents 0.41a _{0.23-0.73 0.51}a _{0.29-0.92 0.44 0.19-1.01 1.27 0.72-2.23 0.98 0.57-1.68}

Livingalone+economicallyindependent 0.40a _{0.20-0.79 0.46}a _{0.22-0.96 0.04}a _{0.01-0.37 0.74 0.35-1.58 0.35}a _0.17-0.70

Economicallyindependent+someonedependsonme 1.18 0.24-5.84 0.22 0.02-2.10 1.23 0.11-13.80 4.77 0.96-23.59 1.47 0.29-7.57

Occupation No 1 - 1 - 1 - 1 - 1 -Yes 2.30 0.81-6.54 2.08 0.74-5.84 5.20 0.60-45.10 3.03 0.74-12.39 1.20 0.42-3.44 Jobsecurity perception Secure 1 - 1 - 1 - 1 - 1 -Insecure 4.64a _{2.90-7.43 2.55}a _{1.58-4.12 2.75}a _{1.40-5.39 1.62 0.99-2.66 2.38}a _1.50-3.78

Incomeperception Unsatisfactory 1 - 1 - 1 - 1 - 1

-Poor 0.36 0.10-1.27 0.52 0.14-1.87 0.38 0.09-1.61 0.50 0.12-2.05 0.72 0.18-2.84 Adequate 0.18a _{0.52-0.65 0.21}a _{0.06-0.77 0.22}a _{0.52-0.94 0.38 0.09-1.58 0.59 0.15-2.35} Excellent 0.05a _{0.01-0.26 0.09}a _{0.02-0.05 0.29 0.05-1.82 0.72 0.14-3.62 1.09 0.22-5.32} Congenital disorders No 1 - 1 - 1 - 1 - 1 -Yes 1.24 0.59-2.62 1.19 0.54-2.65 1.39 0.51-3.81 0.85 0.38-1.90 0.98 0.47-2.01

aOR:adjustedoddsratio;95%CI:95%confidenceinterval.

Furthermore,thispilotstudyshowsthatanadequateor excel-lentincomeisaprotectivefactorofdepressive/anxioussymptoms andalcoholintake,differingfromoneotherstudy.35

Inconclusion,theanalysisoftheexistenceofassociationswithin labourmarketandmentalhealthissuesmayleadtocontroversial conclusions.Becauseofthis,itisimportanttostudyandconsider allthemainaspectsthatcouldinterveneandinfluencespecific out-comes.Itisnecessarytoperformotherspecificlongitudinalstudies andtodevelopastrongadvocacyoflabour’spolicymaking, coher-entwiththespecialneedsofthisspecificportionofyoungworkers. Moreover,itisimportanttounderlinebothpointsofstrength andweaknessofthestudy.Firstofall,few similarstudieshave beenconductedtoanalysetheyoungworker’ssituationafterthe 2008financialcrisis.Alltheincludedstudiescollecteddatafrom differentcountries,thusmakingthemdifficulttocompareamong eachother,sinceeachcountryhasitsownwelfaresystem. More-over,asetofdifferentvalidatedscaleswasusedtostrengthenthe assessmentoftheoutcomes.Ontheotherhand,thewaythesample wasselected,andthepilotstudydesign mayhave ledto selec-tionbiasesanditcannotbeconsideredasfullyrepresentativeof thepopulationofItalianyoungworkers;atthesametime, cross-sectionalstudiescannotgivestrongevidenceofcausalconnections amongthedifferentvariables.Anotherpotentiallimitationofthis andotherstudiesthattouchsensitivetopicsistheriskof under-reportingofsomeimportantdataaboutmentalhealthproblems orsubstancesabuse.Sincethesetopicshavebeenassessedwith questionnaires,theinterviewedsubjectsmayhaveomittedsome informationabouttheirrealcondition.

This pilot study conducted in a single Italian city provided importantinformationabouthowtoperformmorespecific multi-centrestudieswithlargersamplesizes.Thesestudiescouldexplore thisissueinsouthernEurope,inordertopointoutpotential differ-enceswithothereconomicalsystems,basedonstrongerevidence. Ethicalstandards

Theauthorsassertthatallprocedurescontributingtothiswork complywiththeethicalstandards oftherelevant national and institutionalcommitteesonhumanexperimentationandwiththe HelsinkiDeclarationof1964anditslateramendments.

Whatisknownaboutthetopic

After 2008 economic crisis the labor market changed. Jobinsecurityincreased amongyoungworker.Fewstudies assessedthepossibleassociationwiththeincreasedjob insta-bilityandpoormentalhealth.Inparticular,lowerincomeand genderseemtoaffectthisassociation.Butthisconditioncould differsubstantiallyfromdifferentareasintheworld.

Whatdoesthisstudyaddtotheliterature?

Thispilotstudytrytooutlinethisassociationamongmore than500youngItalianworker.Furthermore,thestudyassess thepossibleassociationbetweenjobinsecurityanddruguse, smokinganddrinkinghabit.Jobsecurityperceptionappears tobe themostimportant predictivefactorfor theoutcome assessed, affectingnotonlymentalhealth butalcohol con-sumptionandsmokinghabit.

Editorinchief

CarlosÁlvarez-Dardet.

Transparencydeclaration

Thecorrespondingauthoronbehalfoftheotherauthors guar-antee the accuracy, transparency and honesty of the data and informationcontainedinthestudy,thatnorelevantinformation hasbeenomittedandthatalldiscrepanciesbetweenauthorshave beenadequatelyresolvedanddescribed.

Authorshipcontributions

Alltheauthorssubstantiallycontributedintheconceptionand designofthework,datacollection,analysisand/orinterpretation ofthedata.Theygavetheircontributioninwritingthearticleor gaveanimportantintellectualcontribution.Theyallapprovedthe finalversionofthepaper.Furthermore,eachofthemagreetobe accountableforallaspectsoftheworkinensuringthatquestions related totheaccuracyor integrityof anypartof theworkare appropriatelyinvestigatedandresolved.

Funding None.

Conflictofinterest None.

References

1.Istat.TutelaDellaSaluteEAccessoAlleCure.(Accesed22/08/2018.)Available

at:https://www.istat.it/it/files//2014/07/salute9-luglioDEF14-luglio.pdf

2.BartleyM,FerrieJ.Glossary:unemployment,jobinsecurity,andhealth.J

Epi-demiolCommunityHealth.2001;55:776–81.

3.ISTAT.Rapportoannuale2016.LasituazionedelPaese.(Accesed22/08/2018.) Availableat:https://www.istat.it/it/files/2016/05/Ra2016.pdf

4.VirtanenM,KivimäkiM,JoensuuM,etal.Temporaryemploymentandhealth:

areview.IntJEpidemiol.2005;34:610–22.

5.Quesnel-ValléeA,DeHaneyS,CiampiA.Temporaryworkanddepressive

symp-toms: a propensity score analysis. Soc Sci Med. 2010;70:1982–7.

6.Waenerlund A-K, Virtanen P, Hammarström A. Is temporary employment

related to health status? Analysis of the Northern Swedish Cohort. Scand J Public

Health. 2011;39:533–9.

7.Pirani E, Salvini S. Is temporary employment damaging to health? A longitudinal

study on Italian workers. Soc Sci Med. 2015;124:121–31.

8.Cottini E, Lucifora C. Mental health and working conditions in Europe. ILR Rev. (Accesed 22/08/2018.) Available at: https://digitalcommons.ilr. cornell.edu/ilrreview/vol66/iss4/9

9.RodriguezE.MarginalemploymentandhealthinBritainandGermany:does

unstableemploymentpredicthealth?SocSciMed.2002;55:963–79.

10.BardasiE,FrancesconiM.Theimpactofatypicalemploymentonindividual

well-being:evidencefromapanelofBritishworkers.SocSciMed.2004;58:1671–88.

11.LiukkonenV,VirtanenP,KivimäkiM,etal.Socialcapitalinworkinglifeandthe

healthofemployees.SocSciMed.2004;59:2447–58.

12.GashV,McGinnityF.Fixed-termcontracts—thenewEuropeaninequality?

ComparingmenandwomeninWestGermanyandFrance.Socio-EconomicRev.

2007;5:467–96.

13.BenavidesFG,BenachJ,Diez-RouxAV,etal.Howdotypesofemploymentrelate

tohealthindicators?FindingsfromtheSecondEuropeanSurveyonWorking

Conditions.JEpidemiolCommunityHealth.2000;54:494–501.

14.McGovernP,SmeatonD,HillS.BadjobsinBritain:nonstandardemployment

andjobquality.WorkandOccupations.2004;31:225–49.

15.Benach J, Muntaner C. Precarious employment and health: developing a research

agenda. J Epidemiol Community Health. 2007;61:276–7.

16.Menéndez M, Benach J, Muntaner C, et al. Is precarious employment more

dam-aging to women’s health than men’s? Soc Sci Med. 2007;64:776–81.

17.von Elm E, Altman DG, Egger M, et al. Strengthening the reporting of

obser-vational studies in epidemiology (STROBE) statement: guidelines for reporting

observational studies. BMJ. 2007;335:806–8.

18.Cittàdi Torino.Annuario Statistico della Cittàdi Torino: 2015.(Accessed 22/08/2018.) Available at: http://www.comune.torino.it/statistica/

osservatorio/annuario/2016/pdf/ANNUARIOTestoUnico2016.pdf

19.KroenkeK,SpitzerRL,WilliamsJB.ThePHQ-9:validityofabriefdepression

severitymeasure.JGenInternMed.2001;16:606–13.

20.AmericanPsychiatricAssociation.DiagnosticandStatisticalManualofMental Disorders.4thed.TextRevision(DSM-IV-TR).Washington:APA;2000.982p.

22.BohnMJ,BaborTF,KranzlerHR.TheAlcoholUseDisordersIdentificationTest

(AUDIT):validationofascreeninginstrumentforuseinmedicalsettings.JStud

Alcohol.1995;56:423–32.

23.GavinDR,RossHE,SkinnerHA.Diagnosticvalidityofthedrugabusescreening

testintheassessmentofDSM-IIIdrugdisorders.BrJAddict.1989;84:301–7.

24.EtterJF,DucTV,PernegerTV.ValidityoftheFagerströmtestfornicotine

depen-denceandoftheHeavinessofSmokingIndexamongrelativelylightsmokers.

Addiction.1999;94:269–81.

25.Hosmer DW, Lemeshow S. Applied logistic regression. New York: Wiley; 2000,

375 p.

26.Evans-Lacko S, Knapp M, McCrone P, et al. The mental health consequences of

the recession: economic hardship and employment of people with mental health

problems in 27 European countries. PLoS One. 2013;8:e69792.

27.Gili M, Roca M, Basu S, et al. The mental health risks of economic crisis in

Spain: evidence from primary care centres, 2006 and 2010. Eur J Public Health.

2013;23:103–8.

28.Mattei G, Ferrari S, Pingani L, et al. Short-term effects of the 2008 Great

Reces-siononthehealthoftheItalianpopulation:anecologicalstudy.SocPsychiatry

PsychiatrEpidemiol.2014;49:851–8.

30.Sargent-CoxK,ButterworthP,AnsteyKJ.Theglobalfinancialcrisisand

psycho-logicalhealthinasampleofAustralianolderadults:alongitudinalstudy.Soc

SciMed.2011;73:1105–12.

31.ChanCH,CaineED,YouS,etal.Suicideratesamongworking-ageadultsinSouth

Koreabeforeandafterthe2008economiccrisis.JEpidemiolCommunityHealth.

2014;68:246–52.

32.TennantC.Work-relatedstressanddepressivedisorders.JPsychosomRes.

2001;51:697–704.

33.Astell-Burt T, Feng X. Health and the 2008 economic recession: evidence from

the United Kingdom. PLoS One. 2013;8:e56674.

34.ten Have M, van Dorsselaer S, de Graaf R. The association between type and

number of adverse working conditions and mental health during a time of

economic crisis (2010-2012). Soc Psychiatry Psychiatr Epidemiol. 2015;50:

899–907.

35.Lee S, Guo W-J, Tsang A, et al. Evidence for the 2008 economic crisis exacerbating