Are Occupational Complexity and Socioeconomic Position Related to Psychological Distress 20 Years Later?

The age group above retirement age is the fastest growing age group in many countries. As most diseases and disorders occur in higher ages, this implies that there will be higher demands on the health care and pension systems. Even though many have argued that societies are facing an economic and demographic challenge, it is arguably also a great success; more people reach old age and live longer. But some groups of individuals tend to be healthier than others.

There is a socioeconomic gradient of health in old age. In other words, individuals of lower socioeconomic position in the social structure have higher risks of adverse health outcomes in old age than those of higher socioeconomic position. There are many different explanations as to how socioeconomic position is related to health outcomes in general, and in old age, but the mechanisms are still not fully understood. Some suggested explanations for the socioeconomic gradient in health are based on selection, materialistic conditions and human capital. Work environment has also been suggested to be one of the possible mechanisms that play a role in the socioeconomic gradient of health. People of higher socioeconomic position often have better work environment than those of lower positions. Work environment in late working life may also be related to health much later as it could have long-term effects on health.

Our recent paper studied the link between occupational complexity and psychological well-being in old age in the Swedish context (Darin-Mattsson et al 2015). We proposed that occupational complexity, that is a work environment strongly related to socioeconomic position, is associated to mental health above and beyond socioeconomic position. For example, more complex work environments engage the worker, generating positive effects on mental health, greater intellectual stimulation, and reduced drain of the physical resources already being depleting by the process of aging. Thus, the positive effects of engaged work would be associated with better psychological well-being decades later even when adjusting for socioeconomic position.

We approach well-being from the perspective of psychological distress. Psychological distress is a negative state of mind often indicated by feelings of anxiety and depressive symptoms and it is related to many other adverse health outcomes and mortality. Also, it is a common mental disorder in old age with increasing prevalence after retirement age. About 40% of Swedish women and 30% of men aged 80-84 years reported moderate or severe anxiety and depression (Molarius et al 2009).

We combined two nationally representative surveys of the Swedish population—the Swedish Level of Living Survey (LNU), which took a random sample of approximately 1‰ of the Swedish population aged 18-75 and the Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD), which is a continuation of LNU that enrolls LNU members when they reach the upper age limit (Lennartsson et al 2014). Both surveys have high response rates ranging from 78% to 95%.

We studied occupational complexity and socioeconomic position in the ages 46-64 years (general retirement age in Sweden is 65) in relation to psychological distress more than 20 years later (age 69-88). Each occupation was given a complexity score. We used complexity scores from the U.S. Dictionary of Occupational Titles (Cain and Treiman 1981) that were built on the environmental complexity hypotheses (Kohn and Schooler 1983). These scores was weighted and calculated to fit occupations in the U.S. Dictionary of Occupational Titles (Roos and Treiman 1981) and then matched to Swedish occupations. To differentiate complexity from socioeconomic position, given that the two variables are related, we obtained as detailed measurement of socioeconomic position as possible, using an index of years of education, income, cash margin (respondents were asked if they could manage to gather a certain amount of money within two weeks), and occupation-based social class. But also note that, for example, an architect, where socioeconomic position is high, will have low complexity scores with respect to at least one type of complexity—complexity of work with people—and working as waiter (relatively low socioeconomic position) will have rather high scores on this complexity dimension. Besides socioeconomic position, we also adjusted for age, sex, family status, interaction of sex and family status, hours worked the year before survey year, childhood conditions, and psychological distress at baseline.

First, we investigated the long-term association between occupational complexity in midlife and psychological distress in old age and found that higher occupational complexity was related to less psychological distress in old age.

Second, higher socioeconomic position in midlife was associated to less psychological distress in old age.

Finally, higher occupational complexity was related to less psychological distress 20 years later independently of socioeconomic position.

We conclude that having a job with high occupational complexity in midlife can have a positive influence on psychological well-being much later in life regardless of socioeconomic position. Work environment is an area that is possible to modify and a good target for health enhancing strategies and policies. To increase mental health in old age it could be beneficial to engage workers in this work environment as much as possible.


Cain, P. S., & Treiman, D. J. (1981). The dictionary of occupational titles as a source of occupational data. American Sociological Review, 253-278.

Darin-Mattsson, A., Andel, R., Fors, S., & Kåreholt, I. (2015). Are Occupational Complexity and Socioeconomic Position Related to Psychological Distress 20 Years Later? Journal of aging and health, 27(7), 1266-1285.

Kohn, M. L., & Schooler, C. (1983). Work and personality: An inquiry into the impact of social stratification. Ablex Pub.

Lennartsson, C., Agahi, N., Hols-Salén, L., Kelfve, S., Kåreholt, I., Lundberg, O., Parker, M. G. & Thorslund, M. (2014). Data resource profile: The Swedish Panel Study of Living Conditions of the Oldest Old (SWEOLD). International journal of epidemiology, 43(3), 731-738.

Molarius, A., Berglund, K., Eriksson, C., Eriksson, H. G., Lindén-Boström, M., Nordström, E., Ydreborg, B. (2009). “Mental health symptoms in relation to socio-economic conditions and lifestyle factors–a population-based study in Sweden.” BMC Public Health, 9(1), 302.

Roos, P. A., & Treiman, D. J. (1980). “DOT scales for the 1970 Census classification.”

This entry was posted in Ageing, Health, Inequality and Poverty, Unemployment, Welfare by Alexander Darin-Mattsson. Bookmark the permalink.
Alexander Darin-Mattsson

About Alexander Darin-Mattsson

Alexander Darin-Mattsson is a PhD student at Aging Research Center (ARC), Karolinska Institutet and Stockholm University, Stockholm, Sweden. Alexander has an MSc in sociology. His main fields of interest are in social stratification, social gerontology/epidemiology, health inequalities, and long-term effects of working environment on late life health. His doctoral work focuses on socioeconomic position and work environment (occupational complexity) relation to health in old age, separately and combined, using a life-course perspective. The overall aim is to clarify and understand why groups of individuals have differentiated health in old age, with focus on positions within the social structure as a health developing process.

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