BMJ 2001;322:647 ( 17 March )

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Employment status and health after privatisation in white collar civil servants: prospective cohort study

Jane E Ferrie, senior research fellow, ^a Pekka Martikainen, senior research fellow, ^b Martin J Shipley, senior lecturer in medical statistics, ^a Michael G Marmot, director, ^a Stephen A Stansfeld, professor of psychiatry, ^c George Davey Smith, professor of clinical epidemiology. ^d

^a International Centre for Health and Society, Department of Epidemiology and Public Health, University College London Medical School, London WC1E 6BT, ^b Department of Sociology, PO Box 18, 00014 University of Helsinki, Finland, ^c Department of Psychiatry, Basic Medical Sciences Building, Queen Mary, University of London, London E1 4NS, ^d Department of Social Medicine, University of Bristol, Canynge Hall, Bristol BSS 2PR

Correspondence to: J Ferrie j.ferrie{at}public-health.ucl.ac.uk

Objectives: To determine whether employment status after job loss due to privatisation influences health and use of health services and whether financial strain, psychosocial measures, or health related behaviours can explain any findings.
Design: Data collected before and 18 months after privatisation.
Setting: One department of the civil service that was sold to the private sector.
Participants: 666 employees during baseline screening in the department to be privatised.
Main outcome measures: Health and health service outcomes associated with insecure re-employment, permanent exit from paid employment, and unemployment after privatisation compared with outcomes associated with secure re-employment.
Results: Insecure re-employment and unemployment were associated with relative increases in minor psychiatric morbidity (mean difference 1.56 (95% confidence intervals interval 1.0 to 2.2) and 1.25 (0.6 to 2.0) respectively) and having four or more consultations with a general practitioner in the past year (odds ratio 2.04 (1.1 to 3.8) and 2.39 (1.2 to 4.7) respectively). Health outcomes for respondents permanently out of paid employment closely resembled those in secure re-employment, except for a substantial relative increase in longstanding illness (2.25; 1.1 to 4.4). Financial strain and change in psychosocial measures and health related behaviours accounted for little of the observed associations. Adjustment for change in minor psychiatric morbidity attenuated the association between insecure re-employment or unemployment and general practitioner consultations by 26% and 27%, respectively.
Conclusions: Insecure re-employment and unemployment after privatisation result in increases in minor psychiatric morbidity and consultations with a general practitioner, which are possibly due to the increased minor psychiatric morbidity.

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