BMC Public Health 2008, 8:159 http://www.biomedcentral.com/1471-2458/8/159 five years (from age 25 until age 29) rather than to ten years. In Sweden the trial period for obtaining permanent employment is six months. Therefore, among those who obtained employment, one year of permanent paid work was considered to be a valid measure of firm establish- ment in the labour market. A question that needs to be raised is whether the group "without permanent employment" mainly consisted of unemployed. If so, our study would not contribute to the already existing evidence on reemployment after unem- ployment and health. However, the group did not consist mainly of the unemployed, but had an unstable labour market position in a broader perspective. The multivariate analysis presented in this study was con- trolled for some important confounders. Nevertheless, there are other possible confounders which were tested (such as level of education, substance use and other indi- cators of externalising problems) that may influence one's psychological health during this time period. None of them changed the significant association between psycho- logical symptoms and labour market status. In addition, the number of independent variables must be kept low in order to decrease the risk of mass significance. The impor- tance of unemployment and social exclusion for health has also been more and more emphasised, for example in the WHO Commission of Social Determinants of Health [50]. Labour market position has been shown to be a key determinant of health [2,50,51]. Our findings regarding the importance of labour market programmes for health are in accordance with those statements, even though it is never possible to take all possible confounders into account. The multivariate analysis model was tested separately for men and women, which gave similar results, indicating that obtaining employment was important to both men and women. Therefore, in order to increase the power and avoid the risk of Type II errors due to a small number of subjects in the subgroups, we chose to adjust for gender in the multivariate analysis. On the results In relation to psychological symptoms we confirmed our hypothesis that reemployment after being in an unstable labour market position was associated with a lower prob- ability of having psychological symptoms. Thus, our study indicated that the transition from an unstable labour mar- ket position into permanent paid work seemed to improve psychological health among both men and women. This trend is also found in some of the other available studies in the field [3,5,6]. A longitudinal study of the German population shows that reemployment has a positive effect on health satisfaction for both men and women [6]. Of the analysed possible confounders, we did not find any significant association with psychological symptoms in the multivariate regression. Our results are supported by a German study of reemployment [6] where none of the included confounders, except having children among women, was found to have an effect on the dependent variable (health satisfaction). Overall, the association between obtaining permanent employment and psychological symptoms was not influ- enced substantially by including the possible mediators in the multivariate analyses. However, three possible media- tors seemed to be related to the dependent variable. The strong association between health outcome and ina- bility to do what a person wanted could be explained by the fact that people in unstable labour market positions may be expected to take any available job. Moreover, stud- ies on labour market conditions indicate the negative health effects of being "locked-in" at non-preferred and undesired work [19]. The multivariate analysis showed strong association between high demands and the psychological symptoms. High demands in a newly obtained job can be a new stres- sor that adds additional strain to the strain accumulated during unemployment. From a theoretical point of view our results may be interpreted as if the high demands related to getting permanent employment among men were worse than the exposure to strain in an unstable labour market position. This finding is in concordance with another Swedish study indicating that the psychoso- cial work environment could be worse in permanent jobs than in temporary jobs, especially with regard to higher demands and more stress [17]. However, our study could not verify that the other variable in the strain model – low control, was related to the outcome variable [21]. In accordance with the theory of latent functions [15], obtaining permanent employment could lead not only to a better economic situation but also to improved self- esteem. However, the association between the psycholog- ical symptoms and a feeling of being looked down upon suggests that this may not be the case. On the other hand, those who obtained permanent employment did not report significantly higher experience of being looked down upon than those in permanent employment (Tables 1a and 1b). It seemed that the studied measure of self-esteem might operate in other contextual situations rather than in obtaining a job. Page 9 of 11 (page number not for citation purposes)