Macht Arbeitslosigkeit krank?

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Abstract
Unemployment appears to be a complex condition that burdens the individuals affected in multiple ways both at job loss and in long-term unemployment. To a lesser extent unemployment may also relieve the stressors and risks associated with the place of work. The scope and nature of the burden experienced depends on individual factors, such as mental stability and coping resources, on economic, social and cultural factors, such as availability of alternative roles, system of social security and social context. In the industrialized countries, especially in the Federal Republic of Germany, financial security and society's attitudes towards unemployment are less unfavourable than during the economic recession between the two world wars. Nevertheless, household income should not be overlooked as an important factor leading to stress beyond a certain threshold. In this respect it is noteworthy that the income of the unemployed households in the Federal Republic of Germany decreased by 8% between 1981 and 1983 (Brinkmann, 1986). Quantitative relationships between unemployment and physical health have frequently been reported. In studies whose designs allow such associations to be explained selection factors, i. e. an overrepresentation of frequently or chronically ill and disabled individuals among those losing their jobs and the long-term unemployed, contribute to the increased morbidity among the unemployed to a considerable extent. Causal relationships between unemployment and physical health risks have not yet been proven directly, which does not mean that there are none. The mediation of health risks by changes in behaviour during unemployment which as such might lead to or reduce morbidity and mortality risks has not yet been studied sufficiently. Unemployment appears to have both an increasing and a reducing effect, but also no effect at all on the use of alcohol and tobacco in different populations. But we do not yet know enough about the mechanisms bringing about these effects. There are more consistent findings indicating that sustained unemployment influences personal well-being. This influence is reflected primarily in unspecific physical complaints and mild or moderately severe depressive changes of mood. The most important finding of increased health risks in the unemployed versus the employed are elevated rates of suicide and attempted suicide. This finding, too, seems to be attributable to selection factors, i.e. predominantly to an overrepresentation of mental disorders and substance abuse associated with an increased suicide risk among job-losers. Mentally and physically ill individuals are presumably also more susceptible to stressors associated with unemployment. Selection and stress factors might therefore have a cumulative effect. But this assumption has not yet been sufficiently verified. There are differences between males and females and various age groups in coping with unemployment: married women are less affected if their husbands are employed. In higher age groups the prospect of retirement and old-age pension has an alleviating effect. In adolescents and young adults becoming unemployed before entering the labour force risks of social disintegration in the form of dissocial or criminal behaviour seem to be greater than health risks. Due to the rising requirements for entering or re-entering employment, unemployment rates among the chronically mentally ill - and presumably all those handicapped by chronic or frequently recurring deficits- have risen alarmingly. From a medico-social point of view the weakest, i.e. those members of society that are most vulnerable in terms of their physical and mental health, are most disadvantaged when the limited job opportunities are allotted. Our society is therefore called upon to provide suitable occupation and employment for the growing numbers of individuals who do not fulfill the rising requirements on the labour market. Arbeitslosigkeit ist offensichtlich ein komplexer Zustand, der den Betroffenen sowohl bei seinem Eintritt als auch bei längerer Dauer in vielfältiger Weise zu belasten, zum kleineren Teil aber auch von Belastungen und Risiken am Arbeitsplatz zu entlasten vermag. Ausmaß und Qualität der erfahrenen Belastung ist von individuellen Faktoren, etwa psychischer Stabilität und Bewältigungsvermögen, und von ökonomischen, sozialen und kulturellen Bedingungen, etwa von der Verfügbarkeit von Alternativrollen, vom System der sozialen Sicherheit und vom gesellschaftlichen Kontext abhängig. Die finanzielle Absicherung und die gesellschaftliche Bewertung von Erwerbslosigkeit sind gegenwärtig in den westlichen Industrienationen, vor allem aber in der Bundesrepublik weniger ungünstig als in der Wirtschaftskrise zwischen den beiden Weltkriegen. Dennoch ist eine Verschlechterung der finanziellen Absicherung der Arbeitslosenhaushalte als eine wichtige Belastungskomponente mit Schwelleneffekt nicht zu übersehen. In der Bundesrepublik Deutschland hatten die Arbeitslosenhaushalte zwischen 1981 und 1983 einen Einkommensverlust von 8% zu verzeichnen [Brinkmann, 1986). Quantitative Zusammenhänge zwischen Arbeitslosigkeit und körperlicher Gesundheit sind zwar vielfach gefunden worden. Wo das Design der Studien eine Erklärung der Zusammenhänge erlaubt, überwiegen Selektionsfaktoren, d.h. die Überrepräsentation von Personen mit häufigen oder chronischen Krankheiten und Behinderungen beim Zugang zum und beim Verbleib im Erwerbslosenstatus. Ein direkter Nachweis kausaler Zusammenhänge zwischen Arbeitslosigkeit und körperlichen Gesundheitsrisiken ist bisher nicht gelungen. Daraus ist nicht zu folgern, daß es sie überhaupt nicht gäbe. Unzureichend untersucht ist bisher die Vermittlung von Gesundheitsrisiken durch Verhaltensänderungen Erwerbsloser, die als solche Morbiditäts- und...

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