Comparing the effects of work-life balance on Comparing the effects of work-life balance on health in Finland, UK and Japanhealth in Finland, UK and Japan

Tarani ChandolaMel Bartley

Department of Epidemiology and Public HealthUniversity College London

””Does conflict between home and work explain the effect of Does conflict between home and work explain the effect of multiple roles on mental health?- A comparative study of multiple roles on mental health?- A comparative study of Finland, Japan and the UK”Finland, Japan and the UK”

Tarani Chandola 1, Pekka Martikainen 1 2, Mel Bartley 1, , Eero Lahelma 3, Michael Marmot 1, Michikazu Sekine 4, , Ali Nasermoaddeli 4, Sadanobu Kagamimori 4

1. International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School2. Population Research Unit, Department of Sociology, University of Helsinki, Finland3. Department of Public Health, University of Helsinki, Finland4. Department of Welfare Promotion and Epidemiology, Toyama Medical and Pharmaceutical University, Toyama, Japan

International Journal of Epidemiology (in press)

Substantive QuestionsSubstantive QuestionsDoes conflict affect mental health functioning?Does conflict differ between domestic roles?Does conflict ‘explain’ differences between domestic roles in mental health functioning?

Comparative QuestionsComparative QuestionsGender differencesCross National Differences

Family-to-work conflictFamily-to-work conflictTo what extent does your family life and family responsibilities interfere with your performance on your job in any of the following ways?Would you say:-Family matters reduce the time you can devote to your jobFamily worries or problems distract you from your workFamily activities stop you getting the amount of sleep you need to do your job wellFamily obligations reduce the time you need to relax or be by yourself

Work-to-family conflictWork-to-family conflictTo what extent do your job responsibilities interfere with your family life?Would you say:-Your job reduce the amount of time you can spend with the familyProblems at work make you irritable at homeYour work involves a lot of travel away from homeYour job takes so much energy you don’t feel up to doing things that need attention at home

Domestic RolesMarital Married or Cohabiting vs.

Never Married/Widowed/Divorced/Separated

Parental Presence of Children in the Household under 18

Four Role Combinations1. Not married with child/ren2. Married with child/ren3. Married, no child 4. Not married no child

SF-36 Mental Health FunctioningSF-36 Mental Health Functioning

Role limitations due to emotional problemsDuring the past four weeks have you had any of the following problems with your work or other regular daily activities as a result of any emotional problems (such as feeling depressed or anxious)?a) Cut down the amount of time you spent on work or other activities   b) Accomplished less than you would like c) Didn’t do work or other activities as carefully as usual 

Mental HealthHow much of the time during the past four weeks:b) Have you been a very nervous person? c) Have you felt so down in the dumps that nothing could cheer you up? d) Have you felt calm and peaceful? f) Have you felt downhearted and h) Have you been a happy person

Energy/VitalityQ28.How much of the time during the past four weeks:a) Did you feel full of life? e) Did you have a lot of energy? g) Did you feel worn out? i) Did you feel tired?  

SF-36 Mental Health FunctioningSF-36 Mental Health Functioning

Social functioningDuring the past four weeks, how much of the time has your physical health or emotional problems interfered with your social activities (like visiting friends, relatives, etc)? All Most Some A little bit None

During the past four weeks to what extent has your physical health or emotional problems interfered with your normal social activities with family, friends, neighbours or groups?Not at all Slightly Moderately Quite a bit Extremely

General Health PerceptionPlease choose the answer that best describes how TRUE or FALSE each of the following statements is for youa. I seem to get sick a little easier than other peopleb. I'm as healthy as anyone I knowc. I expect my health to get worsed. My health is excellentDefinitely true Mostly true Don't know Mostly false Definitely

falseIn general would you say your health isExcellent Very good Good Fair Poor

Study designStudy design- civil servants in Britain, Finland and Japan- standardised self-report health questionnaire

BritainWhitehall II study of employees working in the London offices of 20 National Government Civil Service departments and recruited in 1985-1988. Response Rate: 73 %

FinlandHelsinki Health Study baseline survey of municipal employees from the City of Helsinki in 2000-2001 and aged. Response Rate: 68%.

Japanquestionnaires were sent to the employees of a provincial civil service on the West coast of Japan in 1998-99. Response Rate: 88 %

Selectionbaseline of the Japanese and Finnish studies or in the third phase of the British study (1991-1993) and were economically active and 40-60 year old

Britain Finland Japan N 6942 5886 2255

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Britain Finland Japan

MenWomen

Mean SF-36 Mental Component Scores (MCS) by gender and Mean SF-36 Mental Component Scores (MCS) by gender and countrycountry

Mean (and 95% CI) Family to Work Conflict by gender and Mean (and 95% CI) Family to Work Conflict by gender and countrycountry

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Britain Finland Japan

MenWomen

Mean (and 95% CI) Work to Family Conflict by gender and Mean (and 95% CI) Work to Family Conflict by gender and countrycountry

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Britain Finland Japan

MenWomen

Percentage distribution of domestic roles by gender and Percentage distribution of domestic roles by gender and countrycountry

Men Women

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Britain Finland Japan

not married no childmarried no child

married with child/rennot married with child/ren

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Britain Finland Japan

not married no childmarried no child

married with child/rennot married with child/ren

Mean (and 95% CIs) of Family to Work Conflict by domestic Mean (and 95% CIs) of Family to Work Conflict by domestic roles, gender and countryroles, gender and country

MenWomen

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Britain Finland Japan

not married no childmarried no child

married with child/rennot married with child/ren

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Britain Finland Japan

not married no childmarried no child

married with child/rennot married with child/ren

Mean (and 95% CIs) of Mental Health Component Scores by Mean (and 95% CIs) of Mental Health Component Scores by domestic roles, gender and countrydomestic roles, gender and country

MenWomen

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Britain Finland Japan

not married no childmarried no child

married with child/rennot married with child/ren

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Britain Finland Japan

not married no childmarried no child

married with child/rennot married with child/ren

Mean (and 95% CIs) of Mental Health Component Scores by Mean (and 95% CIs) of Mental Health Component Scores by family-to-work (F-W) conflict, gender and countryfamily-to-work (F-W) conflict, gender and country

MenWomen

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60

Britain Finland Japan

lowest F-W conflict

averagehighest F-W conflict

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Britain Finland Japan

lowest F-W conflict

average

highest F-W conflict

Mean (and 95% CIs) of Mental Health Component Scores by Mean (and 95% CIs) of Mental Health Component Scores by gender and country, adjusted for Work-to-Family (W-F) & gender and country, adjusted for Work-to-Family (W-F) & Family-to-Work (F-W) conflictFamily-to-Work (F-W) conflict

MenWomen

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Age adjusted Adjusted for age,F-W & W-F conflict

Britain Finland Japan

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Age adjusted Adjusted for age, F-W & W-F conflict

Britain Finland Japan

ResultsResults

- Work-to-Family (W-F) and Family-to-Work (F-W) conflict lowest in Finland and highest in Japan

- Respondents with children had consistently higher conflict scores

- Single parents had poorer mental health functioning, but otherwise, there was little association of domestic roles with mental health functioning

- Both W-F and F-W conflict were associated with mental health functioning, in men and women from all three countries

- The Japanese had poorest mental health functioning while the Finns had the best health.

- Difference in mental health functioning between countries is stronger among women

- The higher levels of W-F & F-W conflict among Japanese women may contribute to their poorer mental health functioning compared to Finnish and British women

Study design problemsStudy design problems

- Different response rates from different countries

- Age differences in the cohorts

- Different survey years

- Public sector employees may not be representative of economically active population

- Cross sectional data from Finland and Japan/ Cross sectional analysis overall

- Selection problems in the British cohort

Interpretation problemsInterpretation problems

- Can the study infer which country has better mental health functioning?

- Can the study infer which country has lower W-F and F-W conflict?

- Inferring causality from cross sectional analyses

- To what extent can the differences between countries (in mental health functioning) be attributed to differences in work-to-family conflict and family-to-work conflict?

Measurement problems SF-36Measurement problems SF-36

International Qualify of Life Assessment Project (IQOLA)International Qualify of Life Assessment Project (IQOLA)1) Multiple Forward and Backward translationsQualitative and quantitative methods to evaluate quality of translation2) Psychometric tests of scaling and scoring assumptions3) Clinical trials and other studies for vallidity and comparability across countries 4) normative data in general population surveys

Hagman E. (1996). SF_36 terveyskysely koetun terveyden ja toimintakyvyn mittarina (in Finnish). Suomen Lääkärilehti 51, 3534_3540.

Japan- Fukuhara (1998)- All reasonable translations of fair were indistinguishable from the translations of good. Term used- amari yokunai (somewhat not good)

- Poor is not the same as qarui (bad or terrible)- not appropriate. Yokunai (not good) - used instead

Measurement problems SF-36Measurement problems SF-36- Cultural norms

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Britain Finland Japan

Definitely true Mostly true Don't knowMostly false Definitely false

Percentage distribution of responses to ‘I seem to get sick a little easier than other people’

Conclusions Conclusions

For cross national comparisons

Advantages

1) Harmonised study designs- similar populations, similar questionnaires

2) Expected associations- Conflict with Roles and Mental health functioning

3) Policy implications

Disadvantages

1) Cross sectional

2) Interpreting country differences in Mental Health functioning