Insufficient time for leisure and perceived health and stress in working parents with small children

Abstract

BACKGROUND: More knowledge about how recovery may promote health among parents with small children is needed.

OBJECTIVE: To explore whether insufficient time for leisure was associated with poorer perceived health and higher stress in working parents. A further aim was to explore potential gender differences in the association between insufficient time for leisure and poor perceived health.

METHODS: A postal survey including the perceived stress scale and three measures of subjective health – self-rated health (SF-36), work-related fatigue (Swedish occupational fatigue questionnaire), and Lund subjective health complaints – as well as questions about time for leisure was completed by 965 women and 597 men. Risk ratios for poor perceived health and stress were estimated using Poisson regression, in which also gender interaction was analysed.

RESULTS: The results showed higher risk for perceived stress among parents reporting insufficient time for relaxation, and more subjective health complaints among those reporting insufficient time to spend with their children. Overall, effects were larger among women than among men.

CONCLUSION: A good balance between work and leisure seems to be of importance for working parents’ perceived health and stress.

Keywords

Gender health promotion human activities relative risks

1 Introduction

A large proportion of today’s workforce has to cope with demands at work as well as responsibilities at home. Work life demands may cause strain if they are perceived as high while perception of control is low [1]. Recovery is needed to prevent negative strain effects manifested in direct or indirect health problems, but time for recovery is often restricted [2]. Strain reactions are the main reason for sick leave in Sweden [3]. Having small children may contribute to strain and energy drain [4], and parents with small children have an increased risk of sick leave due to strain reactions [5]. Knowledge about how recovery may increase health is therefore crucial for promoting employee health and preventing strain-related sick leave. Besides recovery, long working hours [6], low educational level [7], increasing age [3], and poor sleep quality [8], have been shown to be associated with poor health and stress.

Leisure is an important mean to recovery [9] and balance between paid work, domestic work, and leisure is important to achieve good subjective health [10, 11]. In Sweden in 2010, parents with small children constituted the group with the most work hours (paid work and domestic work), and least amount of time for leisure [12]. The distribution of hours spent working at home and at work was not equal between genders; whereas women spent on average 1 hour and 17 minutes more per day on domestic work, men spent on average 3 hours more per day on paid work. Both paid and domestic work require effort and may be fatiguing [13]. In contrast, leisure requires less effort, restores resources, provides opportunity for social support, enables people to experience pleasure and relaxation, and includes freedom of choice and sense of control, and may thus have recovering or health promoting effects [14, 15]. Hence, in order to achieve sufficient recovery from work, parents need to balance responsibilities at home with leisure [16], which is expected to provide opportunities for preventing strain and promoting work-lifebalance [17].

The amount of time spent on social or physical leisure has been found to be positively associated with well-being, health, and sufficient recovery in working people [14, 18]. Among police and emergency response service workers, relaxing leisure was found to be the strongest positive predictor of stress coping abilities, while social and cultural leisure (such as attending concerts, theatre, and museums) significantly predicted better mental or physical health [19]. Leisure was important as health promotion for family caregivers [20]. Time to socialize was important for health in dual-income parents with small children [21]. Thus, independent of work characteristics, an association between recovery, i.e. sufficient time for leisure, and perceived health, is plausible.

Negative health effects of work-life imbalance appear to be stronger in women than in men [22]. Moreover, leisure seemed to be more important for working women than for working men [10, 11], and women seemed to appreciate the social interaction aspect of leisure more than men [23]. Nevertheless, to the best of our knowledge, studies on working parents’ time for leisure are missing.

The aim of the present study was to explore whether insufficient time for leisure was associated with increased risk for poor perceived health or higher levels of stress in working parents with small children. A further aim was to explore potential gender differences in the association between insufficient time for leisure and poor perceived health or stress.

2 Method

2.1 Sample

The sample was located through a medical birth registry that covers all births in the health care regions in Southern Sweden. From all women located through this register, 4000 mothers of small children were randomly selected. Of these, 85 were excluded since the family had emigrated, had protected identity, or either the child or mother had died at the time of the study invitation. Invitations for both parents to take part in the present study were sent to the remaining 3915 mothers, who were asked to give one of the questionnaires to the father. Couples who were living together or had joint custody of the child, and where both the man and woman worked at least 50 percentage of full time (40 hours per week) were eligible for inclusion. Couples where one or both had a serious disease or chronic illness, or where the woman was pregnant or had given birth during the last two years were excluded. We have no data on the number of non-respondents, who did not respond because they violated one or more of the inclusion and exclusion criteria. A record check (Statistics Sweden) showed that at the time of the mailing, 879 children had at least one parent who was not in current labour work. Moreover, among those who responded to the study, 22 mothers were excluded since they were currently pregnant, and 35 fathers were excluded since the parents did not have joint custody. Thus, the actual net study sample consisted of 3015 women and 3001 men, resulting in a total of 6016 persons. Of these 1562 responded to the survey (965 women and 597 men). The median age was 37 years, with a range from 19 to 62 years. The majority of the participants had university education, nearly all men and about half of the women worked full-time and about half of them stated that they had enough time for sleep (Table 1).

Ethical approval for the study was applied for and approved by the regional ethical review board, Lund Sweden (215/2008).

2.2 Measures

Perceived stress and health is operationalized as perceived stress, self-rated health, work-related fatigue, and subjective health complaints. It is measured using the following instruments.

Perceived stress scale (PSS), which includes 14 items about different aspects of global stress during the last month [24]. The scale includes items about how unpredictable, uncontrollable, and overloaded respondents find their lives, as well as direct queries about current levels of experienced stress. Each question is rated from never (0) to very often (4). The individual mean score of the 14 items was calculated and dichotomized with the group median as a cut-off point. The PSS has shown adequate reliability [24, 25] and validity [26]. Good internal consistency (Cronbach’s alpha=0.85) was indicated for the current sample.

Self-rated health was measured using one item. The response alternatives range from very bad, could not feel any worse (1) to very good, could not feel any better (7). Self-rated health was dichotomized with the group median as a cut-off point. This single item is considered to be the most reliable and valid one-item estimate of self-rated health [27].

Work-related fatigue was measured using the Swedish Occupational Fatigue Inventory (SOFI-20). SOFI consists of five dimensions of fatigue; lack of energy, lack of motivation, physical exertion, physical discomfort, and sleepiness. It is assessed at the end of a typical work day on a scale from not at all (0) to a very high extent (6). The individual mean score of the items was calculated and dichotomized with the group median as a cut-off point. The internal consistency of the five subscales is good [28]. Excellent internal consistency (Cronbach’s alpha=0.94) was indicated for the current sample.

Subjective health complaints were measured with the Lund Subjective Health Complaints (LSHC). The frequency of subjective health complaints perceived during the last 30 days is indicated on a scale from never (1) to always/almost every day (5). LSHC was developed at the Department of Occupational and Environmental Medicine in Lund, Sweden. Excellent internal consistency (Cronbach’s alpha=0.92) was indicated for the current sample.

Enough time for leisure was measured with a study-specific questionnaire including questions about whether the respondents experienced sufficient time for physical exercise, hobbies, relaxation, and social intercourse with partner, children, relatives, and friends. The response alternatives were yes (0), partly, but I desire more (1), no, far from enough (2), and not interested in this (3). These variables were dichotomized into enough (response alternatives 0 or 3) or not enough (response alternatives 1 and 2) time for each respective leisure.

2.3 Socio-demographic factors

The following socio-demographic factors, known to be associated with perceived health and stress, were also included: age (19–29, 30–39 and >40years), work time (full-time vs. part-time), education(university education vs. other education), and sufficient time for sleep (response alternatives dichotomised as for leisure items described above; yes or no).

2.4 Statistical analysis

Differences in time for leisure, perceived health, and stress between genders were analysed using chi-squared tests. Risk ratios with 95% confidence intervals (CI) for perceived stress, work-related fatigue, poor self-rated health, and subjective health complaints were estimated using Poisson regression. To assess possible effect modification of gender, separate models were run for each combination of exposure and outcome, using interaction terms for gender and each respective exposure variable. The statistical models were performed (1) including all participants, adjusted for gender, and (2) stratified for gender, to further illuminate potential gender differences. All Poisson models were adjusted for age, work time, education, and sufficient time for sleep. Results were considered statistically significant if p < 0.05. All the statistical analyses were performed using the IBM SPSS statistics 20.0 [29].

3 Results

The majority of the participants claimed to have insufficient time for relaxation, physical exercise, hobbies, friends, and partner. About half stated that they had sufficient time for relatives and children. More than half rated their health as good. Women, more often than men, experienced insufficient time for leisure, except for time for partner and children. More women than men claimed to perceive stress, work-related fatigue, subjective health complaints, and had poor self-rated health (Table 1).

3.1 Insufficient time for leisure and perceived stress

Overall, insufficient time for relaxation, physical exercise, friends, relatives, and children, was associated with higher perceived stress. However, only regarding time for relaxation, the effect was apparent among both men and women. Gender interaction was found for insufficient time for exercise, friends, or children, indicating that their effect on perceived stress differed between men and women. Stratified analyses showed that higher perceived stress was related to insufficient time for exercise, friends, or children only among women(Table 2).

3.2 Insufficient time for leisure and poor self-rated health

None of the examined factors were associated with poor self-rated health in the total group. Also, there were no gender interactions. However, the stratified analyses showed that insufficient time for friends was associated with poor self-rated health only among women (Table 3).

3.3 Insufficient time for leisure and work-related fatigue

Overall, insufficient time for physical exercise, friends, and children was associated with higher levels of work-related fatigue. Although the gender interaction was not statistically significant, the stratified analyses showed higher risks only among women (Table 4).

3.4 Insufficient time for leisure and subjective health complaints

There were more subjective health complaints among persons with insufficient time for physical exercise, friends, relatives, or children. The stratified analyses showed that insufficient time for children was associated with more subjective health complaints among both men and women. Regarding the remaining factors, an increased risk for subjective health complaints was found only among women (Table 5).

4 Discussion

4.1 Principal results

The present study showed that women, more often than men, experience insufficient time for leisure, except regarding time for partner and children. More women than men also reported perceived stress, work-related fatigue, subjective health complaints, and poor self-rated health. Furthermore, higher risk for perceived stress were found among working parents reporting insufficient time for relaxation, and higher levels of subjective health complaints among those who experienced insufficient time for their children. Insufficient time, in particular for spending time with friends, seemed to affect women to a greater extent than men.

4.2 Strengths and limitations of the study

A strength of the present study is that mainly valid and reliable instruments were used. However, a limitation was that leisure was assessed as the person experiencing that he/she generally had enough time for leisure, which does not really capture the meaning of leisure. Nevertheless, we assume that if a person desired to engage more in the different aspects of leisure included in the questionnaire, they would also consider this leisure meaningful. Also, the response alternative “not interested/do not want more of this” was categorized as “sufficient time for” the activity. Hence, people who spend little time on the activity but are not interested in more were not categorized as having “insufficienttime for”.

The use of self-reported measures could be another limitation. The gender differences regarding perceived health indicate a health gender inequality. However, it could also to some extent reflect the well-known gender bias, manifested in a general tendency of men to report less complaints in such measures, perhaps related to expectations of masculinity.

Another limitation is the cross-sectional design of the present study, which makes it impossible to critically discuss the causal direction of the associations between the variables. It is also very likely that the explored effects may be bidirectional, in the sense that persons who are less stressed and in better health probably allow themselves more time for leisure.

Furthermore, there may be a selection bias in terms of educational level. The participants are not representative of the whole population in Sweden, as their educational level is higher than in the population in general [30]. This potential selection bias could have affected the results to some degree, as jobs requiring higher education could mean more stress than those where a lower education is sufficient.

A major limitation is the low response rate (26%), and the results should therefore be interpreted with caution. However, the participants were comparable to other healthy populations investigated in previous studies [31, 32]. Furthermore, there are no reasons to believe that the sample is not representative regarding the associations investigated.

4.3 The results in relation to other studies

The present study showed higher risk for perceived stress among working parents reporting insufficient time for relaxation. No gender interaction was found. This is in line with another study showing thatrelaxation leisure is the strongest predictor of coping with stress [19]. Both mothers and fathers had a higher risk for subjective health complaints and work-related fatigue when they experienced insufficient time for their children. These were two of the few associations where the effect was larger among men than women. A possible explanation for this could be the new father role, which involves actively taking care of and doing activities with your children [33]. In the current study, though, the men were fewer and the association between insufficient time for children and work-related fatigue was not significant.

However, insufficient time for children seemed to increase work-related fatigue and perceived stress among women. This confirms the results of previous studies, where women experience more parental stress than men [34, 35]. It could also be interpreted as the subjects following the cultural expectations [36]. In Sweden, women, compared to men, still take a larger responsibility for unpaid work, for example for children [37].

Whereas insufficient time for friends carried an increased risk for all health outcomes investigated for women, no effects were found for men. A possible explanation for this could be that women are socialized to take responsibility for relationships and therefore relationships are more important for women’s health than for men’s [38]. Another interpretation could be that women appreciate the social intercourse aspect of leisure more than men, which is in line with the results of another study [23].

In the present study, the adverse effects of insufficient time for leisure were most evident among women. We found statistically significant gender interactions for several of the exposure-outcome-combinations. The interpretation of this is that men and women react differently to the same level of exposure (i.e. time for leisure). A possible explanation for the gender differences could be lack of time due to family commitments, which confirms the results of previous studies [39, 40]. Another possible explanation could be that women mainly carry out activities for the benefits of others [41, 42], and neglect their own needs for autonomous leisure [43]. According to Such [43], mothers may experience time spent with their children more as childcare or domestic work, while men may experience this time as more resembling leisure time. Sufficient recovery is considered important for men as well as women. In a qualitative study exploring experiences among Swedish men who had sought care for stress related problems, the interviewed men reported to not have made set time for recovery, not considered their health, and neglected early symptoms of stress during the time leading up to the stress-related illness [44]. They either did not exercise at all, or exercised too hard and unstructured. The lack of sufficient recovery, and coping strategies for maintaining balance in life, is discussed as factors contributing to increased risk for stress related and other illness.

An interesting result in the present study was that where associations between insufficient time for leisure and poor self-rated health were found, they were more likely to be found among the women than among men. This confirms the results of previous studies, which showed that leisure was more important for women’s health than for men’s [10, 11]. Thus, insufficient time for leisure may not only prevent women from recovering, it may also add to their stress burden. The results could also be interpreted in terms of work-life imbalance, as women have less balance between work (work and domestic work) and leisure than men [11 , 45]. Again, this would imply that women have fewer opportunities to recover from work, as suggested by Saxbe et al. [16]. This could also help to explain the higher sick leave rates among women due to stress-related disorders, in Sweden.

Further, in the present study more women than men worked (paid work) part-time, and statistically significantly more women than men perceived negative health outcomes. Working part-time has previously been associated with both positive [46] and negative [47] health outcomes among women with a dual workload. Traditional gender ideologies in Western countries cast men as breadwinners, while women are held to be responsible for domestic work and childcare. This result of the present study may be a consequence of a more egalitarian gender ideology in Sweden today, which implies equal opportunities and responsibilities for men and women.

The strength of the associations between different leisure- and health variables vary. This is not surprising, as the different health variables measure different things, and there is no single answer as to what they really measure. However, one could speculate that stress, health complaints, and work-related fatigue are mainly interfered from subjective experiences, and that self-rated health is more related to absence of disease.

Insufficient time for hobbies and partner was not associated with any of the health variables in the present study. This could happen if the participants – consciously or unconsciously – prioritised the other types of leisure, which could be seen as more mandatory from gender and stress management perspectives. This interpretation is in line with the findings of a previous study in women with stress-related disorders, which showed that when the women perceived stress they prioritised mandatory activities at the expense of enjoyable activities [48]. However, this is only a speculation and has to be further studied. Another interpretation could be that the concept of hobby is difficult to interpret, and some of the other types of leisure, such as physical exercise, could also be seen as a hobby.

4.4 Implications and future research

To prevent strain-related sick leave among working parents with small children it is important to focus not only on the work situation but also on the balance between work (paid work and domestic work) and leisure. It is also of importance to teach people more about the importance of leisure as a means of coping with stress, and to enable them to develop and pursue meaningful types of leisure. Furthermore, the division of labour i.e. both paid and domestic work within couples must be clarified, and women need to be aware also of their own needs of leisure and learn to give priority to it.

The effective management of demands from paid work, domestic work, and family as well as management of leisure can have significant effects on workers’ health and performance. Therefore, employers should ensure that the organisation becomes more equal and family-friendly, for example by supporting both men and women to adapt working hours and working time to their family situation and recovery needs. Further, effective work-life policies are needed to promote the attraction of organisations as well as employees’ commitment and job satisfaction.

Further studies are needed about women’s and men’s perceptions of meaning in their activities in everyday life to gain knowledge about which activities men and women perceive as work (mandatory) or leisure (relaxing, joyful or mainly as social intercourse).Furthermore, more research is needed about how women and men handle stress and leisure time availability.

5 Conclusion

Working parents with insufficient time for leisure showed higher risk of poor perceived health and stress. The risks, related to insufficient recovery, were generally greater among women than among men, especially when the women perceived insufficient time for physical exercise, children, and friends.

Conflict of interest

The authors have no conflict of interest to report.

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