Work satisfaction and physical health - Springer Link

Journal of Community Health Vol. 7, No. 4, Summer 1982

WORK SATISFACTION AND PHYSICAL HEALTH Lois M. Verbrugge, Ph.D.

ABSTRACT: This analysis asks how satisfaction with one's main work role (whether that is a paid job or housework) is related to physical health. Data from a Detroit survey show that: (1) Dissatisfied people have poorer health status and take more curative health actions than do satisfied people. The dissatisfied people have higher health risks due to more smoking, drinking, and stress, and they also have health attitudes that encourage symptom perception. Poorer health explains why they take more curative actions; they actually have less faith in the value of medical care and restricted activity and less access to care than do satisfied people. (2) Work satisfaction is more important for nonemployed people than employed ones. Dissatisfied homemakers have especially numerous symptoms and high drug use. And dissatisfied, nonemployed men report a great deal of recent restricted activity and medical care. The data suggest that the homemakers focus on their dayto-day symptoms and try to relieve them by drugs; on the other hand, poor health has forced the men to quit work, and they are very unhappy about the situation. (3) Women (whether they are employed or homemakers) are more sensitive to work satisfaction than are employed men. Apparently employed men adjust better to job stresses and suffer few health consequences, whereas women cannot buffer their dissatisfactions as well. In summary, the Detroit data indicate that work satisfaction is related to good health for both sexes, and that being a dissatisfied homemaker poses especially high risks of poor health.

WORK SATISFACTION AND PHYSICAL H E A L T H Research has shown that people with active social roles (being employed, or married, or a parent) have better health than people without them. Active people have better self-rated health, fewer chronic and acute health problems, and less curative health behavior. Employment has especially strong ties with good health. 1-9 Marriage ranks second, and parenthood third.6,1° People with both job and family roles enjoy the best health; there is no obvious penalty for having multiple roles, for either women or men). 6 How people feel about their roles may also have health consequences. People who are dissatisfied with their activities may suffer increased risks of illness and injury, because they take up smoking, become inattentive to their work, and often feel anxious and stressed. They may also focus more than satisfied people do on physical discomforts and be more eager to adopt the sick The author is Associate Research Scientist, School of Public Health, and Faculty Associate, Institute for Social Research, at the University of Michigan, Ann Arbor, Michigan 48106. The research was funded by a Research Grant (MH29478) from the Center for Epidemiologic Studies, National Institute of Mental Health. The author appreciates comments and suggestions made by the Journal's editor and reviewers. 0094-5145/82/1400-026252.75©

1982 Human Sciences Press

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role. This paper examines people's satisfaction with their main work rolemwhether that is a paid job or housework--to determine whether those who like their work role have better health than those who dislike it.

R E S E A R C H TO D A T E There is some prior evidence that work satisfaction and j o b pressures are related to heart disease and heart disease risk factors (such as high blood pressure and serum cholesterol). 11 In a study of employed women and housewives, for example, the housewives who feel tense about their work or who feel they perform housework poorly have higher blood pressure than other housewives. 12 Furthermore, employed women with low job achievement (low performance, low earnings, no promotions) have higher blood pressure than do their more successful peers. In the Framingham Heart Study, middle-aged men and women who manifest Type A behavior develop coronary heart disease ( C H D ) more frequently than do those with Type B behavior. 13 (Type A behavior is characterized by aggressiveness, ambitiou.sness, competitive drive, and a chronic sense of time urgency.) W o m e n who tend to suppress their anger rather than express it also have elevated C H D risks. Clerical women are especially prone to C H D , and this appears related to their job characteristics (having a nonsupportive boss, low job mobility) and personalities (suppression of anger).14 The Framingham predictors do not measure work satisfaction per se, but they do distinguish people who feel pressured and upset from those who are more content. Finally, people who are satisfied with their work (job or housework) liv e longer than do dissatisfied people. 15-17 Researchers usually interpret these results as evidence that work satisfaction enhances health. However, two studies reverse the causal order and suggest that good health may increase work satisfaction. Employed women who considered their health good are more satisfied with their jobs than other women are. 18J o b satisfaction is also higher among women who have no health problems that cause work limitations. 18,I9

HYPOTHESES ABOUT WORK SATISFACTION AND HEALTH Figure 1 shows a theoretical model of how social roles and role satisfaction affect health. The full model is discussed elsewhere; 5 here, we will focus just on work satisfaction and its possible effects. Work satisfaction may influence health risks, health attitudes, and perceived opportunities for health care. Dissatisfied people may be careless in their activities, or adopt unhealthy life styles, or experience continual stress that taxes their physical well-being. They may also worry about health more,

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focus more on their physical discomforts, interpret symptoms as illness more readily, and seek ways to adopt the sick role. As a result of these attitudes and behaviors, dissatisfied people may ultimately be sicker by medical criteria, experience more symptoms in daily life, take more curative health actions, but probably take fewer preventive ones than will satisfied people. Five hypotheses about work satisfaction and health will be tested here: 1. People who are dissatisfied with their main work role have worse health status than • satisfied people have. 2. Dissatisfied people take more curative health actions but fewer preventive ones, compared with satisfied people. 3. Work satisfaction influences health behavior more than health status. Most health behaviors are discretionary; people can choose to do them or not. Attitudes about work, physicians, drugs, etc., are very important in decisions to take curative or preventive actions. By contrast, morbidity is much less "discretionary," being largely the outcome of health risks. Hypothesis 3 asserts that work satisfaction influences decisions to see a physician, take time off, and use drugs more than it influences illness and injury reports. 4. Work satisfaction has a stronger effectfor nonemployed people than for employed ones. When unhappy with their situation, nonemployed people may have few FIGURE 1: A Model of How Roles and Role SatisfactionInfluence Health

Health Risks (such as work and environmental hazards, life style behaviors, stress)

" "Real • Morbidity" ,.i"

(medicalcriteria)

/

Social Roles and Role Satisfaction

Health Attitudes and Health Care Opportunities

Perceived Morbidity@ (sociomedical criteria)

Health Behaviors (such as restricted activity, chronic activity, chronic limitations, health services use, drug use)

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ways to buffer stress and m a y ultimately suffer m u c h p o o r e r health than their satisfied peers. By contrast, dissatisfied workers m a y have m o r e ways to cope and vent their feelings; if so, health differences beteween dissatisfied a n d satisfied e m p l o y e d people are p r o b a b l y smaller. 5. Work satisfaction has stronger effects for women than for men. This assumes that m e n are able to tolerate u n p l e a s a n t aspects of their jobs b e t t e r t h a n w o m e n can. If so, dissatisfied w o m e n might be m u c h less healthy t h a n satisfied w o m e n , whereas c o m p a r a b l e groups of m e n show smaller differences. In statistical terms, H y p o t h e s e s 1, 2, and 3 involve m a i n (or additive) effects. H y p o t h e s e s 4 and 5 involve interaction effects.

DATA SOURCE AND PROCEDURES The Health in Detroit Study is a survey of white adults (over 18 years of age) residing in the Detroit metropolitan area in the fall of 1978. A multistage probability sample of households was selected. In each household, one adult was chosen as the study respondent. An initial interview was conducted at the household, covering such topics as current health status, health behaviors in the past year, health attitudes, life style behaviors, stress and anxiety, social roles, time constraints and feelings about roles, and other sociodemographic information. Following the interview, respondents kept daily health records for six weeks. Each day they answered questions about their general health status, symptoms, curative and preventive actions, mood, and special events. At the end of the diary period, a Termination Interview was conducted by telephone, with questions about health status, changes in health attitudes and behavior during the diary period, and reactions to the diary task. Innovative aspects of the study design are discussed elsewhere.2°, 21 Data from the initial interview and the daily health records are studied here. There are 714 respondents (302 men, 412 women) who completed an initial interview, and 589 (243 men, 346 women) who kept at least one week of daily health records. Details about response rates and respondent selectivity are available in technical reports. 22-24

Dependent Variables Health variables in the initial interview and daily health records were grouped into six concepts: general health status, morbidity, restricted activity, chronic limitations, health services use or lay consultation, and drug use. The first two concepts concern health status, and the rest are health behaviors. For this analysis, 25 variables were selected, which represent the six concepts; they are described in Appendix 1.* In this article, the term "health" encompasses both health status and health behavior. Saying that a group has "good health" will therefore mean it has good *For diary-keepers who produced less than 42 days of data, their data were inflated to the full 42 days. Thus, no trends were attributed to their behavior. Gentle trends across the six weeks do occur for some items, 24 but they are so modest that the simple imputation procedure (no-trend) is justified.

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general health status and low morbidity rates, and also low rates of restricted activity, chronic limitations, health services use/lay consultation, and drug use.

Independent Variables Two variables measure work satisfaction*: 1. Feelings About Work: Whether R likes or dislikes his/her main work role (l-like, 2-mixed feelings, 3-dislike). This variable exists for all women and for currently employed men: Nonemployed women were asked about housework. Currently employed women reported satisfaction for their job and also housework, and they state which role is more important to them; here, they are scored for the more important role. Currently employed men were asked about their job. 2. Employment Preference: This variable combines employment preference and employment status (1-currently employed, 2-nonemployed and does not prefer to be employed, 3-nonemployed and prefers to be employed). It exists for all women and all men. Several other independent variables are used in the analysis: 3. Sex: (0-woman, 1-man). 4. Employment Status: (0-not Currently employed, 1-currently employed). The first group contains unemployed people and people out of the labor force. 5. Age: Respondent's age at last birthday (in single Jyears). Code letters are assigned to the five variables as follows: W, P, S, E, and A.

Procedures To see how Feeling About Work are linked with health, a series of mult!ple regression equations was estimated for each dependent variable: Model 0 Y =f[A] Controlvariable 1 ~ = f [A,S,E,W] Main effects (Additive model) 2 Y = f[A,S,E,W,ExW] Employment x Feelings About Work interaction 3 ~'= f[A,S,E,W,WxS] Feelings About Work x Sex interaction 4 "P" = f [ A , S , E , W , E x W , W x S ] Full model In the regressions, age is interval-scaled. S, E, W, and the interactions are nominalscaled, so dummy variables for them were constructed. Nonemployed men (N = 49) were deleted, since they were not asked how they feel about housework. Age is used as a control variable in the analysis (since health status tends to decline and health behaviors to increase with age). Model (0) is a baseline model with just the control variable included. Model (1) shows the effects of sex, employment status, and work satisfaction. Coefficients are effects on health net of the other independent variables. Model (2) asks whether work satisfaction affects health differently for nonemployed people than for employed ones. Model (3) asks whether work satisfaction affects women's health more, or less, than men's. Model (4) is the full model with all possible main and interaction effects. -

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* T h e D e t r o i t s u r v e y does not h a v e m e a s u r e s of m a r i t a l o r p a r e n t h o o d satisfaction.

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The regression results were examined as follows: First, for every model, coefficients and R 2 were tested for statistical significance (p.

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Work Satisfaction. People who like their work (job or housework) have significantly better self-rated health, fewer chronic conditions and drug use for chronic conditions, fewer daily health problems, less conversation with friends about symptoms, and better daily moods, compared with people who dislike their work. Note that most of these are health status variables. Coefficients are seldom significant for health behavior items, but they do show consistent signs: Satisfied people tend to have less curative medical care and use fewer drugs than dissatisfied people do; but they have more restricted activity and preventive care. (The preventive items are: preventive visits, number of other drugs, and preventive days.) We will discuss this further soon. People with mixed feelings about their work have a health profile quite similar to that of dissatisfied people. Sometimes it is even worse; they often have more drug use, restricted activity and medical care (both preventive and curative), though these differences are not statistically significant. Among nonemployed people, those who do not want a job have better health than those who do. The first group has better self-rated health, fewer chronic conditions, fewer daily symptoms, less job limitation, less restricted activity, less medical care, less curative drug use, and better daily moods than the second group. Scanning coefficients for all the variables, we see uniformly better health status and less health behavior for the contented nonemployed (with only one exception). In sum, satisfaction with work is clearly related to good health status. But the relationship to health behavior is less clear. For Employment Preference, satisfaction reduces both curative and preventive actions. For Feelings About Work, it boosts some and reduces others. At this point, we must also recognize that active health care by dissatisfied people is due partly to their greater morbidity. To unravel these results better, regressions were rerun for all health behavior items, using both age and morbidity as control variables. For Feelings About Work ( " L i k e " ) , coefficients tend to become positive; to a smaller extent, this is also true for Employment Preference ( " D o not prefer to work").* This means that satisfied people tend to take more curative and preventive care than dissatisfied people do, for reasons unrelated to health status. Do they take better care of themselves, both when ill and not ill, in order to promote their long-term health? When morbidity is controlled, we see that people with mixed feelings about work are more similar to dissatisfied people than before; for some items, they continue to have more active health care. Apparently, ambivalence is as detrimental as outright dissatisfaction, or even more so. Comparing Health Status and Health Behavior. Work satisfaction affects health behavior less than it does health status.** This is true for both Feelings * Results for these regressions are not shown in Tables 2 and 3. ** Significance levels of regression coefficients were compared; they tended to be stronger for health status variables.

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About Work and Employment Preference. The result is contrary to Hypothesis 3, and it suggests that health risks and symptom sensitivity increase sharply for dissatisfied people, more than their willingness to adopt the sick role. To examine this, the two work satisfaction variables were cross-tabulated with 70 items on health attitudes, health care opportunities, life-style behaviors, environmental hazards, and stress: Compared with satisfied women, dissatisfied women feel more vulnerable to illness, tend to see symptoms as signs of illness, have trouble ignoring pain, and feel less responsible for their health. They think about their health more and are less pleased with it. Unexpectedly, dissatisfied women believe less in the efficacy of medical care and restricted activity, and they are less willing to cut down their activities or get medical care when ill, claiming it is difficult to find the time. T h e y also have less access to health care (e.g., have a regular doctor less often, and lose pay if they make a doctor visit). For employed men, work satisfaction is only weakly related to attitudes and opportunities. Sometimes dissatisfied workers report higher symptom perception, but they have no special attitudes about restricted activity or medical care. O n the other hand, nonemployed men who want a job are very distinctive. Compared with their contented peers, they think about health a great deal and say they have quit doing some things that were bad for health. T h e y do not feel responsible for becoming ill; but when they do become ill, they prefer to care for themselves rather than to seek medical care. Dissatisfied women (whether employed or homemakers) also have notably higher health risks than satisfied ones have. T h e y smoke and drink more, report more environmental hazards at their job and home, and experience more recent and long-term stress. Again, relationships are weaker for employed men. And again, nonemployed men who want t o work stand out sharply from other men, having active smoking and drinking behavior, little physical activity, and high mental distress. In sum, dissatisfaction seems to encourage symptom perception and to boost health risks through unhealthy habits and stress, but it discourages health actions. The relationships to perceptions and risks are quite strong; to attitudes about health care, much weaker. Simply put, dissatisfaction causes people to feel worse but does not encourage them to do anything about symptoms. Interactions. Tables 2 and 3 show several significant interaction effects for Feelings About Work (N = 4) and Employment Preference (N = 6). Near-significant interactions are also identified. Plots of the W x S, E x W, and P x S interactions reveal two things: First, work satisfaction is more important for women's good health than for men's. This is especially true for homemakers; when dissatisfied, they experience notably more symptoms and use more drugs than their happier peers. (W x S interactions show that dissatisfied women report more chronic conditions, daily symptoms--especially not very serious ones--lay conversa-

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tion, prescription drug use, and chronic condition drug use than satisfied ones. E x W interactions show that homemakers who dislike their role have m a n y more daily symptoms--especially not very serious ones--use more nonprescription and prescription drugs during the diary period, and have more job limitations than satisfied homemakers do. Similar but smaller differences appear for employed women.)* Second, nonemployed men who want a job are much sicker than those who are content with nonemployment. This difference is much larger than for comparable women. (P x S interactions show that unhappy men have especially numerous restricted activity days and curative medical care, job limitations, and poor moods. Further analysis shows that the frustrated nonemployed men are preoccupied with health troubles. They feel very limited in social activities, and they say that poor health keeps them from having a job. Poor health probably forced m a n y of these men to quit working, but they do not want to retire, and they remain upset about the situation. These men tend to be older than currently employed men but not as old as the contented nonemployed men, who are mostly retirees.) Strength of Predictors (R2). Altogether, the predictors (age, sex, employment status, work satisfaction, two-way interactions) explain a modest amount of variation in health. For Feelings About Work, the R2s range between 0.056 and 0.100 for health status variables and between 0.014 and 0.203 for health behavior variables. For Employment Preference, the ranges are 0.023 to 0.102 and 0.016 to 0.233, respectively. The largest R2s in this analysis appear for job limitations and drug use, mainly because age has such a strong impact on them both. The R 2 increments from Model (0) to (1) are usually significant. This means that sex, employment status, and work satisfaction (as a group) have important links to health. Increments from Models (1) to (2) and (1) to (3) are sometimes significant, signalling two-way interactions, which were identified above. Significant increments from Model (1) to (4) sometimes appear for Feelings About Work; they reflect the two-way interactions already noted. In sum, the effects of sex, employment, and work satisfaction on health are mostly straightforward additive ones. Interactions are less prominent, but the ones that appear routinely point toward the same groups for special health profiles. Readers may want to look at the age-adjusted means in Table 4. With few exceptions, they show the link between satisfaction with work and good health. (Recall that for Feelings About Work, the link is much stronger for women than for men. And people with mixed feelings sometimes have more health care than do those who dislike work.)

* One other E x W effect appears: Employed women with mixed feelings about their work use more preventive and nonprescription drugs than do other employed women. They are especially active users of nutritional supplements, vitamins, and minerals.

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DISCUSSION

Work satisfaction indicates how much a person likes, or dislikes, his/her main work role (whether that is a paid job or housework). The Detroit data show that people who are dissatisfied with their work role have worse health status than satisfied people have. They also take more curative health actions. Results are inconsistent for preventive health actions. These effects are independent of age, sex, and employment status. Dissatisfied people--especially women--feel more vulnerable to illness, are more preoccupied with their health, view body discomforts as illness signs, and find it hard to ignore pain, compared with satisfied people. They also experience more risks from unhealthy life-styles and high stress. These attitudes and risks boost their morbidity (both " r e a l " and perceived). Higher morbidity accounts for their more active health behavior. In fact, when morbidity is controlled, satisfied people appear to take more curative and preventive health actions than dissatisfied people do. This is consistent with their health attitudes: Satisfied people are more willing to cut down their activities or see a doctor when ill, they have more faith in the efficacy of restricted activity and medical care, and they find it less difficult to take time off for illness. Apparently, they believe in the importance of health care, both when ill and when well. Dissatisfied people do not seem to find special excuses to adopt the sick role and be relieved of their work; their morbidity level determines their health behavior. (But recall that their attitude profile boosts perception of symptoms.) These comments indicate how work satisfaction influences health (of. Figure 1). But two very different explanations are also possible: First~ poor health may force some employed people to quit work, and they may be very upset about nonemployment. This is a social selection effect. Second, poor health may lessen people's happiness and fulfillment in their work (job or housework). These further explanations state that health influences work roles and work satisfaction--just the reverse of Figure 1. Altogether, three explanations can underlie the links between work satisfaction and health: satisfaction enhances health; poor health causes nonemployment and dissatisfaction; good health increases satisfaction. The author suspects that the first explanation is a prominent one, but it remains to be demonstrated with other data. Work satisfaction affects health status more than health behavior. As noted above, dissatisfied people (especially women) have higher health risks and symptom perception than satisfied people have. These factors probably boost their symptoms and poor self-ratings of health. Dissatisfied people are actually less willing and able to take curative health actions than are satisfied people, and these factors dampen their health behavior. This becomes visible when morbidity is controlled.

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Dissatisfaction has a much larger effectfor nonemployedpeople than for employed ones. Homemakers who dislike their work have especially high symptom rates and drug use, compared with satisfied homemakers. Nonemployed men who prefer having a j o b report numerous restricted activity days, frequent medical care, and high j o b limitations. The causal routes for these effects may differ for women and men. For the women, dissatisfaction may prompt homemakers to focus on their body discomforts and to relieve their problems by drugs. By contrast, extremely poor health forces some men to quit work. Resisting retirement but unable to return to a paid job, they voice dissatisfaction with their status. These different explanations are buttressed by the data, which show short-term health problems and behaviors for the women, but longer term ones for the men. Moreover, the frustrated nonemploed men have a distinctive profile of risks and attitudes. They report a great deal of stress and have the worst life style behaviors but deny responsibility for their illnesses. Although they prefer to care for themselves when ill, they have actually had a great deal of medical care in the past year. Excluding the nonemployed men, we find that work satisfaction affects women's health more than men's. Whether employed men like or dislike their jobs has little effect on their health. But dissatisfied women (whether employed or homemakers) are decidedly less healthy than their satisfied peers. Dissatisfied women have poorer self-rated health, more daily symptoms, more chronic conditions, and (to a lesser extent) more active health behaviors. W o m e n with mixed feelings about their work have a health profile more like the dissatisfied women than like satisfied ones. In sum, work satisfaction has different effects for four groups: First, nonemployed men who want a j o b are much less healthy than their contented peers (mainly retirees). Their profile suggests social selection. Second, homemakers who dislike taking care of a home have notably poor health status and take numerous drugs, compared with their satisfied peers. Their profile suggests social causation. Third, satisfied employed women are healthier than dissatisfied ones; this effect is less pronounced than for the homemakers. ( R e m e m b e r that employed women are scored for the work role that is most important to them; for some, this is housework.) Fourth, work satisfaction has little effect on employed men. Apparently, men who are dissatisfied with their jobs adjust and tolerate problems better than dissatisfied women do. The most striking finding is for the nonemployed women. The Detroit data reveal a double jeopardy for homemakers: Not only do they experience more work dissatisfaction, but they also suffer negative health consequences for those feelings more than other groups do. One wonders how much the women's movement accounts for the results. In the 1970s, homemaking was often denigrated by feminists, and many homemakers may have lost selfesteem. The social isolation of many homemakers also provides a propitious environment for focusing on personal problems and discomforts and for resolv-

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ing them in private ways (such as drug use). The plight of homemakers might be exaggerated in the popular press, but it cannot be discounted. The Detroit data provide compelling evidence of their difficulties. In summary, of the original hypotheses, Hypotheses 1, 4, and 5 are supported. Hypothesis 3 is not. Hypothesis 2 has qualified support (mostly true before morbidity is controlled, but not after).

CONCLUSION Researchers, politicians, and the public are asking whether multiple roles (having both job and domestic responsibilities) harm women's physical and mental health. Actually, health surveys show that w o m e n - and men--with multiple roles enjoy the best health, and they suffer no health disadvantages for being so busy. 5,6 Still, there may be upper limits to the number of roles that people can have and continue to derive health benefits. And there may be particular role combinations that are especially stressful and detrimental to health; for example, divorced women with preschool children and full-time jobs may have high health risks. In this paper, we have suggested that how people feel about their roles is also important for short-term and long-term health. Unhappy people appear to have elevated risks of illness and injury, and they tend to focus on body discomforts and fret about health. But the Detroit data offer no evidence that dissatisfied people look for ways to escape their work and to adopt the sick role. This paper finds striking relationships between work satisfaction and physical health.* There are other qualitative aspects of roles that merit attention: Among married people, does marital happiness promote health?** Do nonmarried people who want to be married have worse health than those who prefer the status quo; if so, is that due to social causation or social selection? Do people who feel overburdened with child care suffer health consequences? Do people who are unhappy with both work and marriage have especially poor health outcomes? The umbrella question of this and related research is: How do the quantity and quality of roles influence men's and women's health? Ultimately, social scientists hope to identify groups whose lives are especially unsatisfying *Research on mental health shows some parallel results to this analysis: Among married people, employed men are least depressed; employed women are next, then nonemployed women; and nonemployed men are most depressed. 30,31 The same rankings appear for other indicators Of mental distress. 32 (Nonemployed men are not included in the study by Gove and Geerken just cited.) People who are happy with their job or their marriage experience less depression than unhappy people. 3° **There is a little evidence about marital satisfaction and health: Unhappily married people tend to have poorer health status than happily married or divorced people. 33'34 When unmarried and married mothers are compared, the unmarried women have lower morale, higher anomie, lower ego strength, and worse physical health. 35 Mental distress partly accounts for their worse health, but not completely; their poorer health profile persists even after controlling for levels of morale, anomie, and ego strength.

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or overburdened, then determine the specific health risks and attitudes they have which lead to poor health and reduced longevity.

REFERENCES 1. Marcus AC, Seeman TE: Sex differences in reports of illness and disability: A preliminary test of the 'fLxed role obligations' hypothesis. J Health Soc Behav 22:174-182, 1981. 2. Nathanson CA: Social roles and health status among women: The significance of employment. Soc Sci Med 14A:463-471, 1980. 3. Rice DP, Cugliani AS: Health status of American women. ProcAm StatAssoc. (Soc Stats Section): 72-78, 1979. 4. Rivkin MO: ContextualEffects of Families on Female Responses to Illness. Unpublished doctoral dissertation. Department of Social Relations, The Johns Hopkins Unviersity, Baltimore, 1972. 5. Verbrugge LM: Women's social roles and health. In P Berman (ed): Women, A DevelopmentalPerspective. Bethesda, Md, National Institute of Child Health and Human Development, 1982. 6. Verbrugge LM: Multiple roles and physical health of women and men. 1982 (forthcoming). 7. Waldron I: Employment and women's health: An analysis of causal relationships. Int J Health Serv 10:435-454, 1980. 8. Welch S, Booth A: Employment and health among married women with children. Sex Roles 3:385-397, 1977. 9. Woods NF, Hulka BS: Symptom reports and illness behavior among employed women and homemakers. J Community Health 5:36-45, 1979. 10. Verbrugge LM: Marital status and health. JMarriage and the Family 41:267-285, 1979. 11. House JS: Occupational stress and coronary heart disease: A review and theoretical integration. J Health Soc Behav 15:12-27, 1974. 12. Hauenstein LS, Kasl SV, Harburg E: Work status, work satisfaction, and blood pressure among married black and white women. Psych Women Q 1:334-339, 1977. 13. Haynes SG, Feinleib M, Kannel WB: The relationship of psychosocial factors to coronary heart disease in the Framingham Study. III. Eight-year incidence of coronary heart disease. Am J Epidemiol 111:37-58, 1980. 14. Haynes SG, Feinleib M: Women, work and coronary heart disease: Prospective findings from the Framingham Heart Study. A m J Public Health 70:133-141, 1980. 15. Palmore EG: Physical, mental, and social factors in predicting longevity. Gerontologist9:103-108, 1969. 16. Palmore EG: Predicting longevity: A follow-up controlling for age. Gerontologist9:247-250, 1969~ 17. Palmore EG: Predicting longevity: A new method. In EG Palmore (ed.): Normal Aging II. Durham, NC, Duke University Press, 1974, 281-285. 18. SheaJR: Work attitudes, satisfaction, and job attachment. In Dual Careers, Vol 1. Manpower Research Monograph No 21. Washington, DC, Department of Labor, 1970, 173-210. 19. Andrisani PJ: Job satisfaction among working women. Signs 3:588-607, 1978. 20. Verbrugge LM: Female illness rates and illness behavior: Testing hypotheses about sex differences in health. Women and Health 4:61-79, 1979. 21. Verbrugge LM: Health diaries. Med Care 18:73-95, 1980. 22. Camburn D: Performance in the Daily Health Records. Technical Report No 5, Health in Detroit Study. Ann Arbor, Institute for Social Research, The University of Michigan, 1980. 23. Keogh L: Selectivity of Interviewed Respondents. Technical Report No 3, Health in Detroit Study. Ann Arbor, Institute for Social Research, The University of Michigan, 1980. 24. Keogh L, Camburn D: Selectivity of Diary Respondents. Technical Report No 6, Health in Detroit Study. Ann Arbor, Institute for Social Research, The University of Michigan, 1981. 25. Verbrugge LM: Sensitization and fatigue in health diaries. Proc Am Stat Assoc. (Survey Research Methods Section):666-671, 1981. 26. Newberry P, Weissman MM, Meyers JK: Working wives and housewives: Do they differ in mental status and social adjustment? A m J Orthopsychiatry 49:282-291, 1979. 27. Feld S: Feelings of adjustment. In FI Nye, LW Hoffman (eds): The EmployedMother inAmerica. Chicago, Rand McNally, 1963, 331-352. 28. Verbrugge LM: Sex differentials in health. Public Health Reports, July/Aug. 1982. Also in AH Stromberg (ed): Women, Health, and Medicine. (forthcoming) 29. Waldron I, Herold J, Dunn D, et al: Reciprocal effects of health and labor participation among women--Evidence from two longitudinal studies. Jl Occup Med 24:126-132, 1982.

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30. Radloff L: Sex differences in depression: The effects of occupation and marital status. Sex Roles 1:249-265, 1975. 31. Rosenfield S: Sex differences in depression: Do women always have higher rates? J Health Soc Behav 31:33-42, 1980. 32. Gove WR, Geerken MR: The effect of children and employment on the mental health of married men and women. Social Forces 56:66-76, 1977. 33. Cole S, Lejeune R: Illness and the legitimation of failure. Am Sociol Rev 37:347-356, 1972. 34. Renne KS: Health and marital experience in an urban population. J Marriageandthe Family 34:338-350, 1971. 35. Berkrnan PL: Spouseless motherhood, psychological stress, and physieial morbidity. J Helath Soc Behav 10:323-334, 1969.

A P P E N D I X 1. H E A L T H S T A T U S A N D H E A L T H B E H A V I O R ITEMS Brief descriptions of the 25 dependent variables used in this analysis are provided here. Initial Interview Self-rated health status (1 --- excellent, 2 = good, 4 -- fair, 5 = poor). Total number of chronic conditions or symptoms present in past year. N u m b e r of restricted activity days due to illness or injury in past year. (Includes bed days, work-loss days, and other days R cut down usual activities.) Index of j o b limitations. (1 --- no limitation, 2 = limits in kind of j o b or amount of work at a job, 3 = unable to have a paying job) N u m b e r of visits to medical doctor for curative care in past year. N u m b e r of visits to medical doctor for preventive care in past year. N u m b e r of medications or treatments curremly used for chronic problems. N u m b e r of other pills or medicines currently taken (for preventive or other reasons).

Daily Health Records (DHR) All items are for the whole six-week diary period. Average physical feeling. (Each day, R answered, " H o w did you feel physically t o d a y ? " with a rating from 1 = terrible to 10 = wonderful.) N u m b e r of symptomatic days. (Range = 0-42)" Total number of health problems during diary period. (The D H R had a Symptom Chart for each day. Repondents entered details about health problems experienced that day, with one problem per line of the chart. This

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variable is the number of health problems summed across the 42 Symptom Charts. If the same problem occurred on more than one day, it is counted several times.) N u m b e r of " v e r y serious" or "somewhat serious" health problems. (Respondents evaluated the seriousness of each health problem they experienced.) N u m b e r of " n o t very serious" health problems. N u m b e r of restricted activity days. (Includes days spent in bed, cut down on household chores or errands, missed work, missed school, or cut down other planned activities.) N u m b e r of restricted activities. (Number of restrictions on each day, summed across the 42 diary days.) N u m b e r of days with curative medical or dental care. (Includes days R made an appointment, telephoned an office/clinic, visited an office/clinic, was admitted to the hospital, or had other curative medical care.) N u m b e r of curative medical/dental care activities. N u m b e r of curative activities on each day, summed across the 42 diary days.) N u m b e r of days with preventive medical or dental care. N u m b e r of days talked with friends or family about symptoms. N u m b e r of days took pills, medicines, or treatments (for curative or preventive reasons). N u m b e r of pills, medicines, or treatments taken. (The D H R had a Drug Chart for each day. Respondents entered details about drugs taken that day. This variable is the n u m b e r of drugs named, summed across the 42 Drug Charts. If the same drug was used on more than one day, it is counted several times.) N u m b e r of nonprescription drugs taken. N u m b e r of prescription drugs taken. Average mood. (Each day, R answered " H o w were your spirits today?" with a rating from 1 -- terrible to 10 = wonderful.) N u m b e r of days with special event. (Each day, R answered " D i d anything h a p p e n - - f o r better or worse--to make today different than usual?") Note: The last two items (mood and special events) do not fit into the six health concepts discussed. T h e y measure disruptions of mental and social well-being, rather than physical well-being.