Work and family roles and the association with depressive and anxiety disorders: Differences between men and women

Abstract

Background

This study examined the associations of (combinations of) social roles (employee, partner and parent) with the prevalence of anxiety and depressive disorders and whether social roles contribute to the explanation of the female preponderance in these disorders.

Method

This was a cross-sectional study using data from 3857 respondents aged 25–55 of NEMESIS (Netherlands Mental Health Survey and Incidence Study). Depression and anxiety disorders were measured using the CIDI 1.1.

Results

The OR of depressive disorders and anxiety disorders among women compared to men was 1.71 (95% CI: 1.40–2.10). Among both genders, the partner role was associated with decreased risks of depression and anxiety and the parent role was not. The work role was a significant protective factor of depression and anxiety for men (OR = 0.40; 95% CI: 0.24–0.69) but not for women (OR = 0.86; 95% CI: 0.66–1.12). The effect of the work role was positive among women without children (OR = 0.28; 95% CI: 0.14–0.54), but not among those with children (OR = 1.01; 95% CI: 0.75–1.35). The gender risk for depression and anxiety decreased significantly by adding the work role variables into the model.

Limitations

This was a cross-sectional study. This study did not give insight into the quality of social roles.

Conclusion

The work role contributed to the explanation of the female preponderance in depression and anxiety disorders. Considering depression and anxiety among women, a focus upon quality and meaning of the work role, and barriers in combining the work role and parent role may be essential.

Introduction

In modern societies, the prevalence of depression and anxiety disorders is highest among people in their midlife, during their reproductive years. The prevalence is also consistently higher among women compared to men (Alonso et al., 2004, Bebbington et al., 1998, Bijl et al., 1998, Kessler et al., 2003). The aspects of the social environment may contribute to the gender difference in the risk of depression and anxiety disorders (Maier et al., 1999, Piccinelli and Wilkinson, 2000). Social roles, such as working in a paid job, being a partner, parenthood, and the combination of these roles might have a part in this. Concerning their mental health, men probably profit more from certain social roles than women.

Working can be advantageous as well as disadvantageous for the mental health (Stansfeld et al., 1999, Siegrist, 1996, Karasek and Theorell, 1990, Iacovides et al., 2003). In general, working people have a better mental health compared to people who are not working (Alonso et al., 2004). Having a job provides a meaningful daytime program, increases the social economic status, and provides possibilities of self-realization (Sieber, 1974). On the other hand, the job demands can be a source of stress, resulting in mental health problems (Karasek and Theorell, 1990, Maslach et al., 2001, Virtanen et al., 2006, Plaisier et al., 2007). Besides having a job or not, also the amount of working hours may play a role in the association of work with mental health. Compared to part-time jobs, full-time work usually provides more money and better careers. Nevertheless, working many hours may overburden someone and therefore may have a negative impact on mental health. Particularly in the case of combining social roles, such as work combined with childcare, scarcity of time and energy might be a cause of stress. Because generally women have more childcare tasks than men, more hours of paid work may increase the risk for stress among those with children. Furthermore, women on average have a poorer quality of work compared to men: less job control, a lower occupational level, and lower salaries (Crompton and Harris, 1998, Fagan and Burchell, 2002, Plaisier et al., 2007). Therefore, among women employment may have a less favourable impact on mental health than among men.

Family roles, such as being a partner or a parent may also be associated with mental health. Being a partner is associated with a positive effect on mental health (Horwitz et al., 1996, Helbig et al., 2006). The partner is one of the most important sources of daily emotional support (Wade & Kendler, 2000). Some studies have found gender differences in the effect of spousal support on mental health, e.g. Schwarzer and Guiterrez-Dona (2005) showed that men profit more from spousal support compared to women. In addition, the parent role, and its effect on mental health may differ for men and women. Helbig et al. (2006) found an association of parenthood with lower rates of particularly depressive disorders that was stronger among men than among women. Although men's participation in domestic work increased during the last decennia, in couples with children women generally spend more time on domestic work such as child care compared to their husbands (Barnett et al., 1994, Sullivan, 2000). This may also depend on the age of their children; younger kids need more care, and therefore make a larger appeal to time and physical energy of parents. On the other hand, teenagers and adolescents may demand more of parents in a psychological way. A probable other aspect of parenthood is the age at which the transition into parenthood took place. In particular, women who gave birth to their first child at a relatively older age may have had more possibilities to develop a professional career compared to younger mothers (Blossfeld & Huinink, 1991) and may therefore be in a more favourable position than younger mothers.

In addition to an effect of a certain social role, the combination of social roles may have an influence on mental health. According to the role accumulation theory, having more social roles may be associated with better mental health among both genders. An adequate combination of more social roles may provide energy (Sieber, 1974, Nordenmark, 2002) and having more social roles provide possibilities to compensate the negative experiences in one role by better experiences in other roles (Thoits, 1983). On the other hand, according to the role–strain theory, some combinations of social roles may be particularly stressful, such as being a working parent without support from a partner (Cairney et al., 2003).

In this paper, data of NEMESIS (Netherlands Mental Health Survey and Incidence Study) will be used to describe the associations of work and family roles with depression and anxiety disorders among men and women in the age of 25 through 55 years. With this study, associations of social roles (employee, partner, and parent) and role characteristics with the presence of depression and anxiety disorders will be explored, and it will examine to what extent social roles contribute to the explanation of gender differences in the prevalence of these disorders. Studies that examine the (gender differences in) associations of social roles with diagnoses of depressive and anxiety disorders measured by the CIDI interview (Robins et al., 1988) in a large community sample are scarce. The first hypothesis of this study is that all three social roles will be positively associated to better mental health, but stronger among men compared to women. The second hypothesis is that having more social roles is better for one's mental health, but a particular role combinations, such as being a parent without a partner, are disadvantageous for the mental health. Finally, we hypothesize that gender differences in the association of social roles with mental health can contribute to the explanation of the female preponderance of depression and anxiety disorders.