Which theory is best? Explanatory models of the relationship between unemployment and health

BACKGROUND: A number of different models have been used in order to explain the links between unemployment and ill-health. The objective of this study was to test different proposed models in an empirical setting. METHODS: A cohort of school-leavers consisting of more than 1000 persons was followed for 14 years up to the age of 30. They have repeatedly been asked questions that could be used to operationalise different proposed models as well as health outcomes. Seven different models explaining the health effect of unemployment were identified: an economic deprivation model, a lack of control model as well as a locus of control model, a stress model, a social support model, a work involvement model and a model of latent functions. Health outcomes used were somatic symptoms, depressive symptoms, self-perceived health and nervous problems. Statistical tests included bivariate correlations and logistic regression. RESULTS: Most of the models correlated fairly well with unemployment measures. The capacity of the models to explain the connection between unemployment and ill-health varied, however. The model of latent functions was most successful, followed by the economic deprivation model. The social support and the control models were also fairly good. The work involvement scale and the stress model demonstrated the smallest explanatory power. CONCLUSION: Studies comparing different explanatory models in the field are rare. Few models apply a multidisciplinary approach. In view of the findings, it should be possible to develop multidisciplinary and better models to explain the links between unemployment and health in more detail.