The mental health effects of multiple work and family demands

A prospective study of psychiatric sickness absence in the French GAZEL study
  • Maria Melchior
  • Lisa F. Berkman
  • Isabelle Niedhammer
  • Marie Zins
  • Marcel Goldberg



Individuals who experience work stress or heavy family demands are at elevated risk of poor mental health. Yet, the cumulative effects of multiple work and family demands are not well known, particularly in men.


We studied the association between multiple work and family demands and sickness absence due to non-psychotic psychiatric disorders in a longitudinal study conducted among members of the French GAZEL cohort study (8,869 men, 2,671 women) over a period of 9 years (1995–2003). Work stress and family demands were measured by questionnaire. Medically certified psychiatric sickness absence data were obtained directly from the employer. Rate ratios (RRs) of sickness absence were calculated using Poisson regression models, adjusting for age, marital status, social support, stressful life events, alcohol consumption, body mass and depressive symptoms at baseline.


Participants simultaneously exposed to high levels of work and family demands (≥2 work stress factors and ≥4 dependents) had significantly higher rates of sickness absence due to non-psychotic psychiatric disorders than participants with lower levels of demands (compared to participants exposed to 0–1 work stress factors and with 1–3 dependents, age-adjusted rate ratios were 2.37 (95% CI 1.02–5.52) in men and 6.36 (95% CI 3.38–11.94) in women. After adjusting for baseline socio-demographic, behavioral and health characteristics, these RRs were respectively reduced to 1.82 (95% CI 0.86–3.87) in men, 5.04 (95% CI 2.84–8.90) in women. The effect of multiple work and family demands was strongest for sickness absence due to depression: age-adjusted RRs among participants with the highest level of work and family demands were 4.70 (1.96–11.24) in men, 8.57 (4.26–17.22) in women; fully adjusted RRs: 3.55 (95% CI 1.62–7.77) in men, 6.58 (95%CI 3.46–12.50) in women.


Men and women simultaneously exposed to high levels of work stress and family demands are at high risk of experiencing mental health problems, particularly depression.


work stress family demands sickness absence depression social disparities 



We thank GAZEL cohort participants who contributed data for this study, as well as EDF-GDF (particularly the Service des Etudes Médicales and the Service Général de Médecine de Contrôle) who collected sickness absence data. We also wish to acknowledge the GAZEL cohort study team responsible for data management. We are grateful to Annette Leclerc and to the participants of the Social Epidemiology research seminar in Paris for helpful comments on earlier versions of this work. Maria Melchior was supported by the U.S. National Institute of Mental Health and a fellowship from the French National Institute of Health Research (Programme Sciences Biomédicales, INSERM-CNRS). Additionally, the authors received support from the Russell Sage Foundation and the National Institute of Aging (NIA).


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Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Maria Melchior
    • 1
    • 2
    • 3
  • Lisa F. Berkman
    • 4
  • Isabelle Niedhammer
    • 2
    • 3
  • Marie Zins
    • 5
  • Marcel Goldberg
    • 2
    • 3
  1. 1.MRC Centre for Social, Genetic and Developmental PsychiatryInstitute of Psychiatry, King’s CollegeLondonUK
  2. 2.INSERM, U687Saint-MauriceFrance
  3. 3.Université Paris XI, IFR69VillejuifFrance
  4. 4.Dept. of SocietyHuman Development and Health Harvard School of Public HealthBostonUSA
  5. 5.CETAF-RPPC, INSERM U687Saint-MauriceFrance

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