Productive activities, mental health and quality of life in disability: exploring the role enhancement and the role strain hypotheses

BACKGROUND: Engagement in productive activities is an important determinant of mental health and quality of life (QoL). Persons with physical disabilities are often confronted with constraints to engage in productive activities and it remains largely unknown whether persons who nevertheless manage to be productive experience beneficial effects for mental health and QoL. This is the first study to analyse different productive activities (paid work, volunteering, education, housework) and its gender-specific associations with mental health and QoL in the disability setting, testing two contrasting hypotheses of Role Theory, the role strain and the role enhancement hypotheses. METHODS: We used data from a representative sample of 1157 men and women of employable age who sustained a severe physical disability (spinal cord injury). Load of engagement in paid work, volunteering, education, and housework was classified into three groups (none; moderate; high). To assess the total productivity load, a score over the four items was calculated. Diversity of engagement was assessed with variables on the number and combination of activities. Tobit regressions were applied to evaluate associations of load and diversity of engagement in productive activities with mental health (Mental Health Inventory, SF-36) and QoL (WHOQoL-BREF items). RESULTS: We found that the total productivity load and the load of paid work were positively related to mental health and QoL in men. Individuals with moderate engagement in volunteering reported better mental health (both genders) and QoL (in women) than those with higher or no engagement. Our results support the role enhancement hypothesis, as mental health (in men) and QoL (both genders) increased with the number of performed activities. In men who had paid work, mental health and QoL increased consistently with each additional unpaid activity. In contrast, engagement in paid work played a minor role for mental health and QoL in women. CONCLUSION: This study in the disability setting provided clear support for the role enhancement hypothesis. Future research on the mechanisms behind the observed associations is warranted to develop interventions and policies that strengthen resources important for engagement in productive activities as well as for mental health and QoL in persons with physical disabilities.