key: cord-0884087-eo9yhz6h authors: Perelman, Julian; Serranheira, Florentino; Pita Barros, Pedro; Laires, Pedro title: Does working at home compromise mental health? A study on European mature adults in COVID times date: 2021-12-11 journal: J Occup Health DOI: 10.1002/1348-9585.12299 sha: 876d3c0b609b0f9f476ff542ad4b7263f535e9f2 doc_id: 884087 cord_uid: eo9yhz6h INTRODUCTION: The COVID‐19 pandemic has transformed working at home (WAH) into the exclusive mode of working for many European workers. Although WAH will likely remain after COVID‐19, its consequences on workers' health are unclear. This study examines the association of WAH and the change of four mental health (MH) domains. METHODS: We used data from the last wave of the Survey on Health, Aging, and Retirement in Europe, collected in June and July 2020 on European people aged 50 and older. We restricted our analysis to people aged 50–65 who were working before COVID‐19 (N = 7065). We modeled the risk of worsening of depression and anxiety feelings, sleeping trouble, and feelings of loneliness as a function of the working situation (usual setting, at home and usual setting, at home only), using logistic regressions. A first model adjusted for sociodemographic variables, a second one adding country fixed effects, and the last one adding the stringency of COVID‐19‐related restrictions. RESULTS: WAH was significantly associated with a worsening of all MH symptoms. Nevertheless, when the stringency index was factored in, no significant association of WAH was found with any of the health outcomes except for anxiety feelings (+4.3% points). However, the increased anxiety feelings among people in WAH were not greater than the one observed among nonworkers. DISCUSSION: Our findings show that WAH was not a major cause of mental health deterioration among European mature adults during the first month of the pandemic. Further evidence is needed on WAH under post‐COVID‐19 “normal” circumstances. The current pandemic of COVID-19 has led authorities of all European countries to impose severe social distancing measures in order to decrease infections and hospitalizations and to avoid deaths. The fight against the COVID-19 pandemic has included, especially, the closing of workplaces, with working at home (WAH) transformed from a marginal practice (fewer than 1 in 20 workers) into the exclusive mode of working for 34% of workers in Europe. 1 The current pandemic may last for years so that restrictions may remain in the long run, at least during certain periods of the year and particularly for high-risk groups, thereby maintaining the WAH practice. At the same time, firms and workers have noticed the advantages of WAH, supported by further digitalization and advanced communication technologies, opening the way for the expansion of WAH beyond the pandemic. In regard to long-term opportunities, based on a survey of occupations' activities, a paper published in September 2020 estimated that 37% of jobs in the USA could be performed from home, reaching more than 40% in Sweden and Denmark. 2 The Eurofound e-survey carried out in July 2020 showed, also, that 78% of workers would be willing to work from home at least occasionally even without COVID-19 restrictions. 1 Concerning economic benefits, a study in Germany showed that firms relying on WAH were less likely to ask for public wage subsidies and to face adverse effects of the crisis while contributing to lower COVID-19 transmission. 3 A randomized experiment in a call center in China showed a 13% increase in performance among WAH employees. 4 A survey carried out in several waves in 2020 in the USA observed that 41% of the respondents reported being more efficient when working from home, whereas only 15% reported the contrary. 5 This survey also detailed why, beyond the potential productivity increase, WAH is likely to increase; in particular, the stigma associated with WAH decreased, the WAH experience during the COVID-19 pandemic was better than expected, a large investment in WAH equipment and infrastructure (with high fixed costs) has already been achieved, and many people may feel a reluctance to return to prepandemic activities. Nevertheless, concerns were raised about the potential downside of WAH on health. In particular, negative effects were expected related to the reduced socialization with colleagues, limited support from institutions, extended working hours, increased sedentarism, and long hours of screen time, as well as the disruption of work-life boundaries, the blurring of which could threaten mental detachment from work. 6 A recent study based on a survey observed a drop in physical and mental well-being, more pronounced among women and low-income persons, related to changes in physical activity and eating habits. 6 However, these negative findings were possibly biased by the confounding effect of COVID-related social restrictions. A rapid review of 23 studies, most carried out before the pandemic, obtained inconclusive results, due to the paucity of studies regarding the impact of WAH on physical health, and contradictory findings pertaining to mental health. 7 The lack of research in this area has also been highlighted recently. 8 There are strong indications that WAH will remain after the pandemic, with potential benefits for firms, but its consequences on workers' health remain unclear. This study examines the association of WAH and the deterioration of four mental health domains, using a representative sample of working European mature adults. We used data from the wave 8/Corona Survey of the Survey on Health, Aging, and Retirement in Europe (SHARE) carried out in June and July 2020 on European persons aged 50 and older (n = 45 033). 9 The SHARE is based on representative samples of the population from each participating country, that is, individuals above 50 were randomly selected using two-or three-stage sampling (depending on the country), with a selection of localities and persons based on local registries, followed by verifying age-related eligibility. The survey was performed by experienced interviewers, who received specific training. More information on the survey design and methods can be found at (http://www.share -proje ct.org/filea dmin/ pdf_docum entat ion/Metho dolog y/Metho dology_2005. pdf). We restricted our analysis to individuals aged between 50 and 65 years old (32 356 observations excluded) who were working before the pandemic ("Employed or self-employed when COVID-19 broke out") (5612 observations excluded). People older than 65 were excluded because 65 years old corresponds to the statutory retirement age in most European countries and the usual threshold used in occupational research and official reports 10 to define the upper limit of the active population. Workers beyond this age were not likely to be representative of the workers' universe due to their more privileged condition, 11 so that including employees above 65 would prone the research to the healthy worker bias. The restriction to a specific age group eliminated indeed the representativity of our sample. Yet, our objective was not to calculate prevalence or incidence but to highlight the relationship between working conditions and mental health among workers, adjusting for several covariates including age. The interviews were carried out in June and July 2020 and included several questions mostly on changes in economic, social, and health situations related to the COVID-19 pandemic. The final sample included 7065 observations. We created binary variables for the worsening of feelings of sadness and depression, feelings of anxiety and nervousness, sleeping difficulties, and feelings of loneliness. To do so, we coded variables as "1" those who declared having faced such difficulties in the last month and declared that these had worsened since the outbreak of the COVID-19 pandemic. The "0" value was thus attributed to those who either declared the absence of trouble or its presence but without worsening due to COVID-19. Our main explanatory variable was the "work setting" indicator, coded into three categories, "working from the usual place," "working from home and from the usual place," and "working at home only." This variable was based on a question explicitly focusing on the COVID-19 period, by asking the respondent about his/her current working situation "since the beginning of the coronavirus epidemic." We included as covariates age (50-54, 55-59, and 60-65) and sex categories, the living condition (alone or not), the education (primary, secondary, and tertiary), and the occurrence of chronic disease since 2017 (diabetes, hip fracture, cancer, hypertension, chronic lung disease, and heart disease). We did not consider the selfreported health variable, which is known to be related to depression symptoms and could thus be tautological. 12 We also did not consider if the person had been infected by COVID-19, given that this occurred to <1% of the sample. Finally, we could not consider if the person already suffered from depression in a previous wave because this information was only available for 253 people (3.5% of the sample), among whom 57 suffered from depression (22.5% of those for whom we have information, and only 0.8% of the complete sample). We then merged this sample with data from the Oxford COVID-19 Government Response Tracker, which includes information on containment and closure, economic, and health system policies. 13 The merging was performed by attributing the COVID-19-related variables to each individual according to his/her country and interview date. In other words, each individual was characterized by the nonpharmacologic responses in his/her country at the moment (s)he was interviewed. We used as covariate the stringency index, which is a score based on 9 items: school closing, workplace closing, cancel public events, restrictions on gatherings, closing of public transport, stay-at-home requirements, restrictions on internal movements, international travel controls, and public information campaigns. Each item includes from three to five categories, from the least to the most severe restriction. The index is constructed as the sum of the scores, reordered on a 0-100 scale, with additional scores if the policy has been implemented nationwide (vs. regional or local implementation). 13 Univariate analyses were performed to measure the association between covariates and dependent variables, and between covariates and WAH indicators, using chi-square tests. All dependent variables were modeled using logistic regressions (with robust standard errors) and reported as risk differences (marginal effects). We first included the WAH variable adjusting for age and sex for living conditions (alone or not) and for the diagnosis of any chronic condition. We then adjusted for country fixed effects (second model) and for the stringency of public health measures (third model). Country fixed effects are expected to capture unobserved country characteristics. In an additional analysis, we compared the outcome of those WAH with those who were not working before the pandemic, using the complete sample of persons aged 50-65 (n = 11 097), using logistic regressions with the same covariates. Indeed, the outcome of people who switched to WAH may be the sum of the effect from switching to WAH and the effect of the pandemic. Since the pandemic effect is more reliably observable among nonworkers (whose working status did not change during the pandemic), we isolated the independent WAH effect by comparing the outcome of people WAH to that those whose working condition did not change. Most employees worked from their usual working place (64.6%), but 18.2% worked from home exclusively (Table 1) . A majority of participants were women T A B L E 1 Sample characterization-workers (frequencies and percentages in italics refer to nonworkers) Table A1 in Appendix shows that "WAH only" is more likely among women, people with tertiary education, and those who experienced a close death. Regarding nonworkers (values in italics in Table 1 ), they are older, less educated, and more likely to suffer from chronic diseases and from mental health symptoms. When adjusting for all covariates except country and stringency, WAH was significantly associated with a worsening of all dimensions (Table 2 ). Yet, when country fixed effects were factored in, no significant association of working at home was found with any of the health outcomes except for anxiety feelings, which was 3.5 percentage points (pp) higher among people working at home exclusively, compared to those working at their usual setting. When the contingency index was accounted for, the significant link with anxiety feelings worsening remained significant (4.3 pp higher risk). Complete results with all covariates are presented in Table A2 in Appendix for the model including country fixed effects. Note, the worsening of all mental health dimensions was less pronounced among men and greater among those who had suffered a chronic disease in the recent past. We then stratified the analysis on the change in any mental health symptom by country, adjusting for all covariates except stringency. Only 6 of 50 estimates showed a statistically significant relationship between WAH and the worsening of any mental health symptom (Table A3 in Appendix). Considering the full sample, WAH was linked to a significantly lower risk of loneliness feelings in comparison with nonworkers ( Table 2) . No other risk differed significantly in comparison with nonworkers including anxiety feelings; in other words, in comparison with people who were not working before or during the pandemic, whose change in psychological status cannot be attributed to changes in working conditions, WAH was not linked to poorer or better outcomes, reinforcing the argument for the absence of a specific WAH effect. WAH is positively related to a worsening of MH dimensions, but this link was mitigated when adjusting for the severity of nonpharmacologic measures against the COVID-19 pandemic, becoming nonsignificant when adjusting for country fixed effects. The relationship with worsening anxiety feelings remained significant in all cases. Nevertheless, this worsening did not differ in comparison with that observed among nonworkers, so that this effect may be more related to the pandemic and not to the specificities of WAH. Pre-COVID results about the link between WAH and mental health are scarce and controversial, 7 and negative effects. A recent paper showed a negative effect of WAH on mental health symptoms 6 but, unlike our study, that investigation focused on a single country and could not control for the severity of nonpharmacologic measures. In our paper, the negative link between WAH and mental health symptoms exists but disappears when the stringency of measures is factored in. In other words, in our sample, WAH did not seem to be a major driver of mental health deterioration, which seemed more related to COVID-related contextual factors. Stated differently, although the pandemic was observed to increase psychologic symptoms, 14,15 WAH does not seem to have been a major cause of this growth. The use of a cross-country sample allows us to evaluate the consistency of the association across various settings and to control for COVID-19 effects. The focus on mature adults allows for the analysis of the relationship on a more experienced working population that is less likely to be affected by precarious jobs and by the adversities of a short working experience. Finally, this study contributes to a new research topic on a new phenomenon that few authors have addressed so far. Our study has some limitations. First is the question on work setting related to participants' situation since the start of the COVID-19 pandemic. It may well be that some people were working at home before that. However, the pre-COVID literature shows that this situation was marginal in most European countries, so we do not expect that this represents a major bias. Second, the data did not allow us to identify the type of job; WAH may be a very different experience for people doing routine jobs with little autonomy and great pressure (e.g., working for a call center) compared with high-skilled jobs enjoying high autonomy (e.g., top managerial positions, researchers, lawyers, etc.). We did not consider the quality of WAH condition, which may vary according to the type of employer (e.g., large vs. small firm, public vs. private sector), and the living arrangement (e.g., if the spouse is also in teleworking or if children are at home). It is too early to draw definite conclusions on the link between WAH and mental health. This study was performed in the first months of the COVID-19 pandemic, characterized by strong uncertainty and fear, and severe restrictions that affected most people's everyday lives, social relationships, and working situations. Also, WAH was-and still is-in its infancy, with firms and people struggling to find the best balance on how to manage this new reality. We, therefore, need to wait for the post-COVID period, when we expect that WAH will be maintained at least partially under new "normal" conditions. Our findings show that WAH was certainly not a major cause of MH deterioration among European mature adults during the first months of the pandemic. Living, working and COVID-19. Luxembourg: Publications Office of the European Union How many jobs can be done at home? My home is my castle-The benefits of working from home during a pandemic crisis Does working from home work? Evidence from a Chinese experiment Why Working From Home Will Stick Impacts of working from home during COVID-19 pandemic on physical and mental well-being of office workstation users A rapid review of mental and physical health effects of working at home: how do we optimise health? Health and telework: new challenges after COVID-19 pandemic Survey of Health, Ageing and Retirement in Europe (SHARE) Wave 8. COVID-19 Survey 1 Interview Date. Release version: 0.0.1. Beta. SHARE-ERIC. Data set OECD. Pensions at a Glance 2019: OECD and G20 Indicators Who in Europe works beyond the state pension age and under which conditions? Results from SHARE Depression symptoms as mediators of inequalities in self-reported health: the case of Southern European elderly Oxford COVID-19 Government Response Tracker. 2020. University of Oxford and the Blavatnik School of Government Older adults and the mental health effects of COVID-19 Mental health and well-being during the COVID-19 pandemic: longitudinal analyses of adults in the UK COVID-19 mental health & wellbeing study The present publication was funded by Fundação Ciência e Tecnologia, IP national support through CHRC (UIDP/04923/2020). We thank Tessa Hannemann, Madina Japakhova, Martin Brieger, and Michael Bergmann for providing us access to the script that helped us to merge the Oxford Coronavirus Government Response Tracker with SHARE data. Any errors are our own.