摘要：Objectives. We systematically reviewed the literature on the impact of returning to work on health among working-aged adults. Methods. We searched 6 electronic databases in 2005. We selected longitudinal studies that documented a transition from unemployment to employment and included a comparison group. Two reviewers independently appraised the retrieved literature for potential relevance and methodological quality. Results. Eighteen studies met our inclusion criteria, including 1 randomized controlled trial. Fifteen studies revealed a beneficial effect of returning to work on health, either demonstrating a significant improvement in health after reemployment or a significant decline in health attributed to continued unemployment. We also found evidence for health selection, suggesting that poor health interferes with people’s ability to go back to work. Some evidence suggested that earlier reemployment may be associated with better health. Conclusions. Beneficial health effects of returning to work have been documented in a variety of populations, times, and settings. Return-to-work programs may improve not only financial situations but also health. The negative effects of unemployment on health have been well documented. 1–5 Several longitudinal studies have shown a relationship between unemployment and mortality. 6–11 The population health consequences arising from periods of economic decline have engendered some controversy, 12 but the evidence on the association between unemployment and poor health is sufficiently robust to suggest causality. 13,14 However, most studies examine the detrimental effects of negative social experiences rather than the constructive effects of positive events. As a result, research into the relationship between employment status and health has predominantly focused on the effects of job loss and unemployment rather than on the health impact of returning to work. The question of whether social factors are a cause or consequence of disease and illness is often framed in the context of the debate over social selection versus social causation and remains a source of controversy. 15–19 The social causation hypothesis suggests that employment leads to health benefits, and the social selection hypothesis proposes that health is a necessary condition for employment. Research suggests that the causation effect may be of greater importance than the selection effect, but both mechanisms may interact and reinforce each other. 15,18 We conducted a systematic review of the research literature on the impact of returning to work on physical and mental health in working-aged adults.
