Research reportChanges in major depressive and generalized anxiety disorders in the national French working population between 2006 and 2010
Introduction
At the beginning of the current economic crisis, WHO (2009) declared that there may be “repercussions of the economic crisis on people׳s health in the form of increase in mental health problems (stress, anxiety and depression) and physical symptoms (cardiac disease, disorders of the digestive system)”. Indeed, the economic crisis may have an impact on social determinants of health such as income, employment, education, nutrition, etc. The WHO also stated that vulnerable populations should be protected because of health inequalities. The report reminds that “investing in health is investing in human development, social well-being and wealth” from the Tallinn Charter, thus investing in health could be one way to revitalize the economy, and to help recover from the economic crisis.
Research on previous economic crises showed increases in all-cause mortality and cause-specific mortality (except for traffic road fatalities), in particular in suicides, in times of economic recession, these increases were associated with economic factors such as unemployment rate (Falagas et al., 2009, Suhrcke and Stuckler, 2012, Uutela, 2010). For example, the study by Chang et al. (2009) suggested an association of the 1997–1998 Asian economic crisis with a sharp increase in suicide mortality in some East/Southeast Asian countries, and that these increases were most closely associated with rises in unemployment. Suhrcke and Stuckler (2012) also emphasized that economic crisis is likely to hit harder poorer countries and poorer, less educated subgroups of population.
To assess the repercussions of the 2008 economic crisis on health, ecological studies were carried out. Most of them found an increase in suicide rate in England (Barr et al., 2012), South Korea (Chan et al., 2014), USA (Reeves et al., 2012), Greece (Vlachadis et al., 2014), Italy (De Vogli et al., 2013), Europe (Stuckler et al., 2011), and 54 countries worldwide (Chang et al., 2013), particularly among men (Chang et al., 2013, De Vogli et al., 2013). However, the changes in suicide rate may depend on countries (Baumbach and Gulis, 2014); for some countries such as Finland, Slovenia and Bulgaria, suicide rate decreased between 2007 and 2010. In Hungary, no increase was detected but suicide rate was steadily decreasing until 2006 and then was stable between 2006 and 2011 (Fountoulakis et al., 2014). Finally, a study in Greece found no change in suicide rate between 2000 and 2010 (Fountoulakis et al., 2013), which may be due to a 2-year lag between the onset of the crisis and the rise in suicide rate as found in another study in Greece (Vlachadis et al., 2014). The increase of suicide rate was found to be associated with GDP (Mattei et al., 2014) and unemployment rate (Barr et al., 2012, Baumbach and Gulis, 2014, Chan et al., 2014, Chang et al., 2013, Fountoulakis et al., 2014, Mattei et al., 2014, Reeves et al., 2012), with a lag of 2–3 months (Chan et al., 2014) or 4–5 years (Fountoulakis et al., 2014).
Several studies exploring individual data assessed the changes in mental health during the 2008 economic crisis in the general population. Studies using diagnostic interview were seldom and showed increase in the prevalence of mood, anxiety, somatoform, alcohol-related disorders (Gili et al., 2013), major depressive episode (Madianos et al., 2011), and no change in suicidal ideation and attempts (Miret et al., 2014).
The increases in mental disorders were associated with unemployment (Gili et al., 2013, Miret et al., 2014), and with personal economic hardship such as mortgage repayment difficulties (Gili et al., 2013, Madianos et al., 2011). Indeed, since the 2008 economic crisis, unemployment has risen from 7.2% to 9.6% in the European Union between 2007 and 2010 with disparities between countries, the increase was of +142.7% in Spain, +51.2% in Greece, +47.2% in the UK, +37.7% in Italy, and only +16.3% in France (Source: Eurostat). Unemployment rate also varied unequally according to occupation, the unemployment rate of manual workers increasing more than the unemployment rate of managers and professionals in France between 2006 and 2010 (+17.5% vs −2.5% respectively) (Source: National Accounts—Base 2010, National Institute of Statistics and Economic Studies).
In the general population, the studies using a diagnostic interview to assess mental disorders were seldom in this topic (Gili et al., 2013, Madianos et al., 2011, Miret et al., 2014) and no study used both a diagnostic interview and a prospective design. To our knowledge, the literature appears even sparser among the working population (Avčin et al., 2011, Chan et al., 2014, Milner et al., 2014, Modrek et al., 2015, Naswall et al., 2011, Vittadini et al., 2014, Wang et al., 2010) with few previous studies using national representative data of the working population or a prospective design, and only one study using a diagnostic interview (Wang et al., 2010). The results of these studies among the working population were mixed. Some of the studies showed an increase in mental disorders, other mental health outcomes, and suicide rate (Avčin et al., 2011, Chan et al., 2014, Milner et al., 2014, Modrek et al., 2015, Wang et al., 2010). However, other studies found no change in mental health complaints, and in use of psychotropic drugs (Naswall et al., 2011, Vittadini et al., 2014). Consequently, there is a major need for more studies among the working population that explore the association between economic crisis and mental health using individual and prospective data, and diagnostic interview. Indeed, mental health at work is a crucial issue involving substantial costs and consequences (Birnbaum et al., 2010, Kessler et al., 2006). It may be assumed that economic crisis may contribute to increase the prevalence of mental disorders. Evidence has been provided by the literature for the general population, but is still missing for the working population. This topic may be of particular interest given the burden of mental disorders at the workplace.
The present study is therefore an attempt to fill the gap in this topic among the working population. This study aimed at assessing the changes in mental disorders between 2006 and 2010, i.e. within the period of the 2008 economic crisis, using prospective national representative data and a structured diagnostic interview to measure both major depressive episode (MDE) and generalized anxiety disorder (GAD), and also at exploring the differential changes in these two disorders according to age, origin, occupation, public/private sector, self-employed/employee status and work contract.
Section snippets
Sample
The study was based on the data from the prospective national representative SIP (Santé et Itinéraire Professionnel) survey, performed by the French Ministries of Labor and Health (DARES and DREES), the French Center for Employment Studies (CEE) and the French National Institute of Statistics and Economic Studies (INSEE). This survey was designed to explore the complex associations between work and health (Coutrot et al., 2010). In 2006, households were randomly selected from the 1999 census,
Results
The study sample was composed of 2679 men and 2921 women working in 2006 and 2010 (Table 1). Significant gender differences were observed. Men were more likely to be manual workers and managers/professionals, and women were more likely to be clerks/service workers. Women were more likely to work in the public sector and to have a temporary work contract and men were more likely to be self-employed. The prevalences of MDE and GAD were almost twice higher among women compared to men. Indeed,
Main results
No changes in MDE and GAD were observed between 2006 and 2010 in the French working population. However, the prevalence of GAD increased significantly among women working in the public sector. Among the general population and among the workers who stopped working for other reasons than retirement, the only significant change was an increase in the prevalence of MDE among men.
Comparison with the literature
The comparison with the literature may be difficult because few studies were performed in the working population and only
Conclusion
In conclusion, no changes in mental disorders were found in the French working population between 2006 and 2010, except an increase in the prevalence of GAD among women in the public sector. These non-significant results might be explained by high levels of social protection in France. Therefore, in times of economic hardship, some particular sub-groups of the population who may be considered well protected, such as the public sector workers, might be of particular interest for prevention
Role of funding source
This study was founded by the French ministry of labor (DARES, Grant no 2200727156) and Université de Versailles Saint-Quentin (Lucile Malard׳s PhD thesis). DARES and Université de Versailles Saint-Quentin had no further role in study design; in the analysis and interpretation of data; in the writing of the manuscript; and in the decision to submit the manuscript for publication.
Conflict of interest
None.
Acknowledgments
The authors thank Nicolas de Riccardis and the work group of the DREES and DARES for their help and advice with the SIP dataset. The authors thank the members of the DARES, DREES, CEE and INSEE, and all the people who participated to the SIP survey and made this study possible.
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