883911 HPQ0010.1177/1359105319883911Journal of Health PsychologySulemana et al. research-article2019 Article Journal of Health Psychology Psychological distress in 2021, Vol. 26(10) 1587 –1596© The Author(s) 2019 Ghana: Are unemployed Article reuse guidelines: sagepub.com/journals-permissions DhttOpsI::/ /1d0o.i.1o1rg7/71/01.13157971/10355391095838139981831911 people more afflicted? journals.sagepub.com/home/hpq Iddisah Sulemana1 , Louis Doabil2 and Ebenezer Bugri Anarfo2 Abstract The detrimental consequences of unemployment to the psychological well-being of people have been well documented. However, much of this research has been conducted for developed countries. This study contributes to the literature by providing empirical evidence on this topic from a Ghanaian perspective. Our results revealed no significant association between unemployment and psychological distress. Rather, we found that part-time and full-time employees who were looking for a job were significantly more likely to suffer psychological distress. When we analysed the association between unemployment and psychological distress for males and females separately, we did not find a statistically significant relationship for either gender group. Keywords gender differences, Ghana, psychological distress, psychological well-being, unemployment Introduction (e.g. Muschalla et al., 2010), unemployment evokes stressful life events (e.g. Bordea et al., Psychological well-being encompasses cogni- 2017; Tefft, 2011) leading to increased psy- tive, behavioural and emotional well-being chological distress (e.g. Carson et al., 2011; (World Health Organization, 2013). The pres- Howe et al., 2012; Yassin et al., 2017). ence of psychological distress is one of the cri- In Sub-Saharan Africa, most countries are teria for determining common mental health still grappling with communicable diseases disorders (e.g. depression, anxiety, etc.). These and poverty (Lancet Global Mental Health, disorders are usually latent although their con- 2007). Psychological disorders account for sequences go beyond the individual to the about 5 per cent of the region’s total disease entire society (e.g. Maj, 2011). Globally, about burden and 19 per cent of all disabilities 284 million people were estimated to have experienced psychological distress in 2017, making the condition a leading cause of men- 1University of Ghana, Ghana tal health and global incapacitation (Ritchie 2GIMPA Business School, Ghana and Roser, 2018). Psychological distress can Corresponding author: therefore be regarded as a silent epidemic. Iddisah Sulemana, Department of Economics, University Because gainful employment provides sub- of Ghana, P.O. Box LG 57, Legon, Accra, 00233, Ghana. stantial material and psychological resources Email: idsulemana@ug.edu.gh 1588 Journal of Health Psychology 26(10) (Amuyunzu-Nyamongo, 2013). High unem- shown that this causal arrow could run from ployment has also bedevilled many parts of the psychological distress to unemployment (e.g. region. It is estimated that the number of Rutter and Rutter, 1993; Schaufeli and Van unemployed people could increase by a mil- Yperen, 1992). In addition, studies on the asso- lion in 2019 due to the region’s high level of ciation between unemployment and psycho- labour force growth (International Labour logical distress have traditionally focused on Organization, 2018). A consequent of the men (e.g. Broomhall and Winefield, 1990; region’s high unemployment situation is an Leeflang et al., 1992) due to the higher number expected rise in psychological distress among of males than females in formal employment. the unemployed. In Ghana, burgeoning unem- However, a relatively small strand of the litera- ployment has culminated into the formation of ture has focused on women (e.g. Dew et al., the ‘Unemployed Graduates Association’. 1992; Ensminger and Celantano, 1990) or both More than 1.2 million Ghanaians above the men and women (e.g. Leinonem et al., 2002; age of 15 are estimated to be unemployed Westman et al., 2004) and have corroborated (Ghana Statistical Service, 2015). Out of this the findings that the unemployed have increased number, about 535,997 are male (representing psychological distress than their employed 42.8%) while 714,916 are female (represent- counterparts. Furthermore, a limited number of ing 57.2%). studies have examined gender differences in Aside from being a means to meeting basic the relationship between unemployment and survival needs, employment provides affec- psychological distress and found no significant tion and self-actualization (Linn et al., 1985). differences among men and women (e.g. Leana Therefore, its absence (especially over a long and Feldman, 1992; Reine et al., 2004; Stokes period) leads to increased psychological dis- and Cochrane, 1984). tress, depression and lower self-esteem in peo- Nevertheless, some scholars have observed ple (Guindon and Smith, 2002; Linn et al., better health outcomes among unemployed 1985). Unemployment may also lead to mental people than among their employed counter- impairment (Vinokur et al., 1996; Warr, 1987) parts. Their argument is that the resilience of and adverse effects on physical health (e.g. the unemployed to overcome life’s adversities Linn et al., 1985). Most of the effects of unem- makes them adopt health-promoting activities ployment on health outcomes are self-reported such as walking and reduced alcohol intake symptoms related to psychological distress (e.g. Charles and DeCicca, 2008; Ruhm, 2003; (e.g. Dooley et al., 1996; Fielden and Davidson, Tefft, 2011). Conversely, Dzator (2013) found 1999) or increased unhealthy behaviours such that economically better-off respondents were as substance abuse that may be a precursor for less predisposed to psychological distress than diseases and suicide (e.g. Dooley et al., 1992; those who experienced ‘hard times’. More Hammarstrom and Janlert, 1994; Lee et al., recently, Amissah and Nyarko (2017) showed 1991). Psychological distress is found to be that unemployed youth manifested poorer psy- correlated with increases in unemployment chological health than their employed counter- (Ensminger and Celantano, 1990; Liem and parts. Their study further revealed that the Liem, 1988). longer one remained unemployed the more In the empirical literature, many scholars their psychological distress deteriorated. Thus, have previously held the view that unemploy- the debate on the nature of the relationship ment leads to increased psychological distress between unemployment and psychological (e.g. Broomhall and Winefield, 1990; Dew well-being remains inconclusive for Ghana. et al., 1992; Eisengberg and Lazarsfeld, 1938; While we contribute to this debate by focusing Ensminger and Celantano, 1990; Leeflang et al., on Ghana, we note that our results may be 1992; Leinonem et al., 2002; Westman reflective of the nature of this relationship in et al., 2004). However, recent studies have Sub-Saharan Africa. Sulemana et al. 1589 Methods part-time? And are you presently looking for a job (even if you are presently working)?’ Participants (0 = no (not looking), 1 = no (looking), 2 = yes, We used data from the Rounds 2 and 3 of the part time (not looking), 3 = yes, part time (look- Afrobarometer Surveys in Ghana. The Afroba- ing), 4 = yes, full time (not looking) and 5 = yes, rometer project is a series of surveys con- full time (looking)). We constructed ‘unem- ducted in many countries in Africa to explore ployed’ equal to 1 if the respondent indicated the economic, social and political attitudes of 1 = no (looking), and 0 = otherwise. Africans about their respective countries (Mattes, 2008; Mattes et al., 2016). Six rounds Control variables are currently publicly available for free while Round 7 interviews are ongoing. For our pur- We controlled for socio-demographic character- poses, we focused on Rounds 2 and 3 because istics including age, gender and education (see, these were the only rounds for which respond- for example, Canavan et al., 2013; Dzator, 2013; ents were asked about their state of psycho- Gillanders, 2016; Sipsma et al., 2013) and other logical distress. In Ghana, the Rounds 2 and 3 covariates of psychological distress in the litera- surveys were conducted in 2002/2003 and ture such as bribery (Gillanders, 2016; Van 2005/2006, respectively. For each round, a Deurzen, 2017), crime victimization (Gillanders, nationally representative sample of 1200 2016; Moore, 2006; Sulemana, 2015), religion respondents was randomly drawn and inter- (Canavan et al., 2013; Sipsma et al., 2013), eth- viewed face-to-face in English and five nicity (e.g. Klineberg et al., 2006; Samaan, Ghanaian languages including Twi, Dagbani, 2000; Takeuchi and Williams, 2003) and rural– Ewe, Ga and Hausa. Each round was con- urban differences (Paykel et al., 2000; Sipsma ducted in each of the 10 regions of Ghana.1 et al., 2013). Dependent variable Statistical analyses We operationalized the dependent variable Because our measure of psychological distress (psychological distress) by exploiting the sur- is ordinal in nature, the study adopts an ordered vey question that asked respondents about their logit model following the approach of previous state of stress or psychological distress. In both studies (Kramer, 1996; McKelvey and Zavoina, Rounds 2 and 3, it was presented as follows: ‘In 1975; Sawkins et al., 1997, p. 127). We ran the last month, how much of the time: Have you ordered logit regression models separately for been so worried or anxious that you have felt each of male, female and the pooled samples for tired, worn out, or exhausted?’ The responses both rounds resulting in 12 models. In Models included 0 = never, 1 = just once or twice, 1–6, we tested for the association between 2 = many times and 3 = always. The merit of this unemployment and psychological distress while measure is that it gives respondents the oppor- controlling for other covariates. In Models 7–12, tunity to attribute their physical tiredness to in addition to unemployment, we tested for other stress (Gillanders, 2016). employment status categories while controlling for other covariates. Specifically, the employ- Explanatory variable ment status categories examined included those out of labour force, unemployed and part-time Our explanatory variable is whether or not the and full-time workers who were either looking respondent was unemployed at the time of the or not looking for another job. We used those in survey. It was worded as follows: ‘Do you have the ‘out of labour force’ category as the refer- a job that pays a cash income? Is it full-time or ence group. 1590 Journal of Health Psychology 26(10) Results observed that, for both rounds, full-time employ- ees who were looking for a job reported relatively From Supplemental Table 1, the average respond- higher psychological distress than unemployed ent reported having experienced psychological individuals. For instance, about 23.70 per cent, distress just once or twice. The majority of 24.48 per cent and 18.52 per cent of full-time respondents had less than a secondary school employees who were looking for a job reported education. Corruption experiences were rela- having experienced psychological distress just tively low, confirming the assertion that bribery once or twice, many times and always, respec- experiences in Ghana or Africa are relatively tively, for Round 2. These are relatively higher modest than perceived (see, for example, Bratton than the corresponding figures of 16.15 per cent, et al., 2005; Justesen and Bjørnskov, 2014; 14.3 per cent and 7.41 per cent for the unemployed Sulemana et al., 2017). Crime victimization was respondents. An identical pattern was observed also low among respondents in both rounds. As for Round 3 where as much as 26.13 per cent and shown in Supplemental Figure 1, almost 40 per 27 per cent of full-time employees seeking another cent of men reported that they had ‘never’ experi- job reported having experienced psychological enced psychological distress within the reference distress many times and always, respectively. period compared to 33.68 per cent of women in Supplemental Table 2 reports our regression Round 2. The corresponding figures for Round 3 results. For all the regression models, we did were 38.75 per cent relative to 38.13 per cent. not find any statistically significant association For each of the psychological distress cate- between unemployment and psychological gories and for both sexes, the proportion of distress.3 However, we found that full-time respondents who indicated ‘never’ exceeded employees who were also looking for another those who indicated ‘just once or twice’ which job were significantly more likely to report high in turn exceeded those who indicated ‘many psychological distress in all six models (Models times’ and so on for Round 2. This observation 7–12). In addition, part-time workers who were also applies to the pooled sample for both also looking for a job were significantly more rounds. In Round 3, however, relatively more likely than those out of labour force to report women reported experiencing psychological high psychological distress (Models 8–12). distress ‘many times’ than ‘just once or twice’. Finally, while relatively more men (5.35%) Discussion reported having experienced psychological dis- tress ‘always’ than women (3.99%) in Round 2, These findings corroborate results of a limited more women (9.21%) experienced psychologi- number of studies that observed that unemploy- cal distress ‘always’ compared to men (7.44%). ment does not influence psychological distress This category of psychological distress aver- (e.g. Dzator, 2013; Feather and O’Brien, 1986; aged 4.60 per cent in Round 2 and 8.40 per cent Gillanders, 2016; Schaufeli and Van Yperen, in Round 3, suggesting an increase in psycho- 1992). For instance, Gillanders (2016) did not logical distress in Ghana between the two find a significant effect of unemployment on rounds of the surveys. Altogether, the fraction psychological distress. However, when the of the respondents who had ever experienced author operationalized psychological distress as some psychological distress was about 60 per equal to 1 if the respondent indicated having cent for both sexes and across both rounds con- experienced psychological distress ‘many firming Sipsma et al.’s (2013) observation that times’ or ‘always’, a negative and significant psychological distress is prevalent among men effect was established, suggesting that the and women in Ghana. unemployed were significantly less likely to We also explored the nature of psychological experience high psychological distress. Our distress over various employment status catego- results contradict prior evidence on the relation- ries.2 As reported on Supplemental Figure 2, we ship between unemployment and psychological Sulemana et al. 1591 distress in developed countries. It may be that that good times can make people sick while bad people who were employed (full time and part times can promote healthy lifestyles. time) but who were looking for another job may Our findings are also consistent with results have suffered work-related stress or job insecu- of prior studies that have shown that older peo- rity and dissatisfaction, and this translated into ple tend to report or suffer higher psychological higher psychological distress for them (e.g. distress (e.g. Dzator, 2013; Paul et al., 2006; Dooley et al., 2000; Furda and Meijman, 1992; Sipsma et al., 2013). It may be that loneliness in Hilton et al., 2008; Witte, 1999). Moreover, the old age and inability to familiarize and interact effect of job insecurity or dissatisfaction is as with neighbours lead to increased depression traumatic (if not more) than the effect of unem- and psychological distress among older people ployment because ‘the anticipation of harm can (Paul et al., 2006). Our results corroborate the have effects as potent as experiencing the harm findings of Sipsma et al. (2013) who observed itself’ (Roskies et al., 1993: 619; Witte, 1999). that women suffer higher psychological distress Another plausible explanation may be that, in than men in Ghana. In addition to work-related the developed world, unemployment hurts psy- stress, women in Ghana may suffer role-related chological well-being because it leads to depres- stress because they perform more domestic sion, psychological distress, low esteem and so responsibilities than their male counterparts and on (Kessler et al., 1989; King and Emmons, may even bear disproportionately higher house- 1990; Schaufeli and Van Yperen, 1992). This is hold and child maintenance costs especially in especially true because unemployment causes polygamous marriages (e.g. Lloyd and Gage- lost income, increased indebtedness and lost Brandon, 1993, 1994; Simon, 1992). Our results social resources (Bartley, 1994; Klasen and also partly confirm the finding of De Menil Woolard, 2009; Witte, 1999) in spite of social et al. (2012) that psychological distress was programmes that may cater for the needs of the lower among Ewes, and that ‘Depression is the unemployed. Arguably, although Ghana does not commonest mental illness of Akan rural women’ have formal social intervention policies or pro- (Field, 1960: 149; Read and Doku, 2012). grammes that provide benefits for or insurance to unemployed people, due to the extended family Limitations system, the unemployed may enjoy some social support that would lessen the negative burden of Our study has several limitations. First, the data joblessness (e.g. Klasen and Woolard, 2009). used here are from 2002 to 2003 and 2005 to Unemployment is also relatively more pervasive 2006, which are relatively dated. However, in developing countries such as Ghana than in VanOver and Lusk (2016) have argued that his- developed countries. Therefore, being unem- toric data on any measure of a given age can ployed may not necessarily cause high psycho- have long-term value if that measure is static. logical distress in Ghana because the unemployed Because human behaviour is generally static may feel that ‘they are not alone’. Consistent (Kenschaft and Clark, 2016) and because psy- with this view, Dzator (2013) found that during chological distress tends to be a relatively static ‘hard times’, unemployment does not lead to measure of human behaviour (Pietri-Taleb et al., sadness, worthlessness or nervousness in Ghana 1994), it could be argued that the data used in but that rather the unemployed are significantly this study are relevant today. Moreover, the less likely to feel hopeless. Because they may rounds used here were the only rounds for which have more time and fewer financial resources, survey participants were asked about their psy- unemployed people may be involved in health- chological distress. Thus, future research could improving activities (e.g. physical exercise, less examine the topic using new data. alcohol consumption, etc.) that could improve Second, our data are secondary data from the their psychological state (Dzator, 2013; Ruhm, Afrobarometer project and do not include some 2003, 2005). Indeed, Ruhm (2003, 2005) argued of the predictors of psychological distress as 1592 Journal of Health Psychology 26(10) shown in the empirical literature (e.g. marital sta- Acknowledgements tus (e.g. Bratter and Eschbach, 2006; Hope et al., We are very grateful to the editor of this journal 1999), financial situation of the household (e.g. (David F. Marks) and two anonymous reviewers Brown et al., 2005; Dakin and Wampler, 2008), for their constructive criticisms and suggestions etc.). Accordingly, this study did not control for that helped us improve the article. A previous ver- these covariates. Third, we have relied on two sion of this study was presented at the 2019 African cross-sectional datasets for our analyses. A more Review of Economics and Finance Conference in ideal approach would be to conduct a longitudi- Johannesburg, South Africa. We are thankful for nal study involving the same participants over the comments from participants at this conference. time. Moreover, a superior approach would be All remaining errors are ours. to conduct a randomized control trial in order Declaration of Conflicting Interests to address the potential endogeneity, selection bias and other problems (see e.g. Deaton, 2010). The author(s) declared no potential conflicts of inter- Finally, we have focused on Ghana. Future est with respect to the research, authorship and/or publication of this article. research could examine the nature of the associa- tion between unemployment and psychological Funding distress at a larger scale by covering other African countries. In spite of these, we believe that our The author(s) received no financial support for the research, authorship and/or publication of this results provide some useful preliminary insights article. into the nature of the relationship between unem- ployment and psychological distress in Ghana ORCID iD and Sub-Saharan Africa generally. Iddisah Sulemana https://orcid.org/0000-0002 -3184-2230 Summary and conclusion Supplemental material In this study, we studied two main issues. First, we examined the relationship between unem- Supplemental material for this article is available online. ployment and psychological distress in Ghana using data from the Rounds 2 and 3 of the Notes Afrobarometer Surveys. Our results from ordered logistic regressions do not support the 1. In 2018, the Government of Ghana created 6 additional regions making a total of 16 regions. established claim in developed countries that However, our study is based on the 10 regions unemployment leads to higher psychological at the time of the surveys. They were Ashanti, distress. Instead, we found some evidence that Brong Ahafo, Central, Eastern, Greater-Accra, people who were employed either part time or Northern, Upper East, Upper West, Volta and full time but who were also looking for a job Western Regions. were significantly more likely to suffer psycho- 2. Those who did not have a job and were not logical distress. Second, when we analysed the looking were considered out of the labour force association between unemployment and psy- and included retirees and discouraged workers. chological distress for males and females sepa- Those who did not have a job but were looking rately, we did not find a statistically significant were the unemployed (the focus of this study). relationship for either gender group. Because The rest of the respondents in the other employ- ment categories were employed (whether part our results revealed that employed people who time or full time, looking or not). were also seeking another job were more likely 3. Canavan et al. (2013) found a strong effect of psy- to report high psychological distress, a policy chological distress on unemployment in Ghana. implication may be that public policy could In other words, their study modelled employment focus on improving working conditions to status as a function of psychological distress. 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