Summary:
The financial crisis, which has affected Greece more than any other European
country, has led, among others, to an increase in unemployment, changes in
employment conditions, as well as an increase of psychosocial risks which employees
are exposed to. Occupational health nurses have a key role in assessing and managing
the adverse impact of occupational hazards that affect employees’ health, especially
in times when fiscal measures lead to unfavorable for the workforce changes.
The aim of this study was to investigate the impact of the economic crisis on the
health status of employees in Greece. In the context of determining the impact of the
economic crisis on workers, perception of the individual about the impact of the
economic crisis, occupational characteristics, employment precariousness and
occupational stress were assessed. Evaluation of the employees’ health status included their physical and mental health, as well as positive or negative changes in
the health status in one year.
The Greek version of SF-36v2 Health Survey Questionnaire was used for assessing
the health status of employees, which includes the four physical health dimensions:
“physical functioning”, “role physical”, “bodily pain” and “general health”, the four
mental health dimensions: “vitality”, “social functioning”, “role emotional” and
“mental health”, as well as the indicators: “physical health component summary”,
“mental health component summary” and “reported health transition”. SF-36v2
health survey questionnaire score is from 0 to 100, with the highest values
representing high levels of health.
For the assessment of the job insecurity, EPRES, the employment precariousness
questionnaire, which includes the six subscales “temporariness”, “disempowerment”,
“vulnerability”, “wages”, “rights” and “exercise rights”, was translated form Spanish
and was validated (Cronbach’s α=0.80). EPRES score is from 0 to 4, with values from 0
to 1 defining low levels of employment precariousness, values from 1 to 2 defining
moderate levels of employment precariousness and values from 2 to 4 defining
extreme levels of employment precariousness.
For the assessment of occupational stress, OSQ, the occupational stress
questionnaire, which includes the four dimensions: “modifying factors and resources
at work”, “perceived environment”, “stress and wellbeing” and “need for support and
interventions”, as well as the seven sub-scales: “job control”, “social relations and
esteem”, “workplace atmosphere”, “leadership and supervision”, “work demands”,
“hazards and environment” and “work strain”, was translated form English and was
validated (Cronbach’s α=0.89). OSQ score is from 1 to 5, with high values defining high
levels of occupational stress.
For the assessment of demographic and occupational characteristics, a
questionnaire was created, which included one item about perceived effect of the
economic crisis. This is a cross-sectional study that took place from 2012 to 2014, using a sample
of 604 employees from 34 companies in Greece. Questionnaires were given at the
workplace to be self-completes by employees and returned to the researcher.
Response rate in the study was 74.11%, whereas an effort was made for the sample
to be as representative of the country's workforce as possible, in terms of age, gender,
occupation and type of contract.
Data collection was performed after the approval by Ethics Committee of the
Faculty of Nursing of the National and Kapodistrian University of Athens, while ethics
principles were respected at all stages of the study. Analysis was performed with the
statistical analysis package SPSS version 23, using descriptive statistics, applying
parametric and nonparametric statistical tests for bivariate analysis and linear
correlation analysis and using multiple linear regression to create models to express
the dependence of employees' health status from employment precariousness,
occupational stress, perceived effect of the economic crisis and individual and
occupational characteristics. Independent variables of the study were employment
precariousness, occupational stress, perceived effect of the economic crisis, as well as
individual and occupational characteristics. Dependent variables were the dimensions
of physical and mental health, as well as reported health transition in one year.
Results from the study show that levels of employment precariousness in the study
sample were moderate (1.54 ± 0.41), with the highest levels of insecurity referring to
“wages” (2.1 ± 0.87) and “vulnerability” (1.39 ± 0.8) of employees. Higher levels of
employment precariousness were found among young employees under the age of 30
(1.76 vs. 1.50, p <0.001), those working for less than one year for their employer (1.78
vs. all other categories with scores of 1.57, 1.51 and 1.45, p < 0.001), blue collar
workers (1.66 vs. 1.49, p <0.001), those employed in the private sector (1.56 vs. 1.41,
p = 0.026), employees who usually work for less than 40 hours per week (2.78 vs. other
categories with scores of 2.15 and 1.81, p <0.001), afternoon shift employees (2.10 vs.
all other categories with scores of 1.49, 1.61, 1.61 and 1.65, p<0.001) and employees
with a temporary employment contract (2.01 vs. 1.43, p <0.001). In terms of occupational stress levels, according to study results, it was found to
be moderate (2.3 ± 0.4), with the highest stress levels referring to “work strain” (3.41
± 0.91) and “perceived environment” (2.74 ± 0.6). Higher levels of occupational stress
were found among employees with Greek nationality (2.30 vs. 1.90, p = 0.022), singles
(2.41 vs. all other categories with scores of 2.20, 2.24 and 2.30, p <0.001), employees
working from 1 to 5 years for their employer (2.41 vs. all other categories with scores
of 2.23, 2.27 and 2.33, p <0.001), those who usually work for more than 40 hours per
week (2.39 vs. other categories with scores of 2.23 and 2.36, p <0.001) those with
health related absenteeism for more than 16 days this year (2.62 vs. all other
categories with scores of 2.24, 2.24, 2.40 and 2.40, p <0.001), employees’ whose shifts
alternate according to their employer needs (2.44 vs. all other categories with scores
of 2.27, 2.31, 2.34 and 2.35, p= 0.012) and employees who feel affected by the
financial crisis due to occupational factors, such as changes in working hours and
wages (2.33 vs. all other categories with scores of 2.12, 2.13 and 2.21, p = 0.003).
Regarding employees' health status, “physical health component summary”
(78.68 ± 14.87) and “mental health component summary” (69.37 ± 18.86) scores show
that study sample employees had good physical health but that mental health levels
were 9.31 points lower than those of physical health. “Health transition” scores
(51.81±17.42) indicate that most employees believe their health is about the same or
somewhat worse than a year ago. The lowest ranked physical health indicator was
“general health” (68.51 ± 17.53), showing a moderate to good self-assessment of their
overall health status, while the lowest ranked mental health indicator was “vitality”
(61.31 ± 20.65), indicating that workers had reduced vitality and energy, with high
levels of fatigue.
In terms of dependence of the employees' health status from employment
precariousness, occupational stress, perceived effect of financial crisis and individual
and occupational characteristics, several independent variables were found to
correlate with dimensions of physical and mental health in the context of bivariate
analysis and linear correlation analyzes. These variables were introduced in
multivariate analyses, using stepwise method, generating models for predicting
physical and mental health dimensions. Regarding physical health dimensions, “physical functioning” was found to be
independently associated with “marital status” (β= 2.850, p= 0.001), “years in the
company” (β=-0.410, p= 0.001), “relevance between studies and job” (β=3.803, p=
0.023) and “overall occupational stress” (β=-14.583, p<0.001). “Physical functioning”
was independently associated with “marital status” (β= 2.850, p= 0.001), “years in the
company” (β=-0.410, p= 0.001), “relevance between studies and job” (β=3.803, p=
0.023) and “overall occupational stress” (β=-14.583, p<0.001). “Role physical” was
independently associated with “rights” (β=-2.815, p= 0.026) and “overall occupational
stress” (β=-21.200, p<0.001). “Bodily pain” was independently associated only with
“overall occupational stress” (β=-23.959, p<0.001), whereas “general health” was
independently associated with “exercise rights” (β=-2.096, p= 0.022) and “overall
occupational stress” (β=-15.738, p<0.001).
Regarding mental health dimensions, it “vitality” was found to be independently
associated with “gender” (β=-4.735, p=0.009), “years in the company” (β=0.211,
p=0.011), “type of job” (β=5.646, p=0.012), “weekly working hous” (β=-0.236,
p=0.011), “vulnerability” (β=3.182, p=0.013) and “overall occupational stress” (β=-
30.233, p<0.001). “Social functioning” was independently associated with “gender”
(β=-6.206, p=0.004), “marital status” (β=-3.225, p=0.003), “weekly working hours”
(β=-0.449, p<0.001) and “overall occupational stress” (β=-27.015, p<0.001). “Role
emotional” was independently associated with “weekly working hours” (β=-0.296,
p=0.006), “absenteeism” (β=0.433, p=0.036) and “overall occupational stress” (β=-
23.922, p<0.001). Employees’ “mental health” was independently associated with
“marital status” (β=-1.810, p=0.037), “type of job” (β=4.528, p=0.029) and “overall
occupational stress” (β=-24.411, p<0.001).
Regarding the indicator of “health transition”, it was independently associated
only with “overall occupational stress” (β=10.429, p<0.001), whereas “physical health
component summary” was associated with “gender” (β=-4.776, p<0.001), ‘exercise
rights” (β=-2.620, p=0.006) and “overall occupational stress” (β=-16.654, p<0.001) and
“mental health component summary” was associated with “gender” (β=-4.543,
p=0.004), “marital status” (β=-2.160, p=0.006), “type of job” (β=4.363, p=0.023), “weekly working hours” (β=-0.264 p=0.002) and “overall occupational stress” (β=-
25.470, p<0.001).
Levels of employment precariousness and occupational stress found in this study
are similar to those found in other studies in Greece during the financial crisis. Selfassessed
health status scores are relatively lower than those reported by most of the
studies that used the same tool in Greece before the crisis, but higher than scores
from studies conducted during the crisis.
In conclusion, although the overwhelming majority of surveyed employees felt
affected by the financial crisis in Greece, this perceived effect did not appear to be an
independent factor for the deterioration of employees' health status. It is estimated
that occupational stress, as well as vulnerability, limited workers' rights and their
inability to exercise them, which are related to the economic crisis and changes in
employment conditions, are factors that have a negative impact on the health of
employees in Greece.
