Elsevier

Public Health

Volume 124, Issue 12, December 2010, Pages 675-681
Public Health

Original Research
Common mental disorders, unemployment and welfare benefits in England

https://doi.org/10.1016/j.puhe.2010.08.019Get rights and content

Summary

Objectives

Individuals who are out of work have a higher rate of common mental disorders (CMD) than individuals who are employed. People who are unemployed in the UK are entitled to welfare benefits to alleviate financial strain. This study examined rates of CMD in individuals who were employed, unemployed and receiving various UK benefits. It also investigated associations between duration of unemployment, gender and CMD.

Study design

An analysis of 5090 working-age participants from the Adult Psychiatric Morbidity Survey 2007, a stratified probability sample survey conducted among adults aged 16 years and over living in private households in England.

Methods

CMD was assessed using the Clinical Interview Schedule (Revised). Information was gathered on sociodemographics, employment, income, benefits and debt. Data were analysed using logistic regression.

Results

Risk of CMD was significantly greater in individuals classified as: unemployed; economically inactive; not working due to physical health reasons; unable to find a suitable job; receiving housing, care or sickness benefit; and receiving income support. However, risk of CMD was not significantly greater in individuals receiving jobseeker’s allowance. Individuals unemployed for less than 1 year or more than 3 years had a higher risk of CMD. Some interactions with gender were significant, with associations being greater in men than women.

Conclusions

Job loss events are not the only reason for unemployed people to develop CMD. The state of unemployment itself may be detrimental to mental health. Risk of CMD is increased in those who have been out of work for 3 years or more. Associations between benefits and mental health are likely to be due to social, health or economic circumstances associated with benefit eligibility.

Introduction

Individuals who are out of work have a higher rate of common mental disorders (CMD, i.e. anxiety and depression) than individuals who are employed. This finding has been consistent throughout Europe1, 2, 3, 4, 5, 6, 7, 8, 9 and the USA.10, 11, 12, 13 Research has been carried out to disentangle the effect of mental health on employment status and vice versa. Evidence supports the hypothesis that job loss and subsequent unemployment have a detrimental effect on mental health.14, 15, 16 Job loss can be considered as a stressor which provokes mental health problems,17 and for which the stressful effects can be attenuated by social support, self-esteem and other coping strategies.13, 18 Unemployment may also create heightened vulnerability to the negative health effects of other stressful life events.13 Some studies have found that the reverse effect is also supported, whereby those with longstanding mental health problems are more likely to become unemployed or never gain employment,11 and those with better mental health are more likely to regain employment.18 However, studies using longitudinal designs have found a higher risk of depression following unemployment, even where there was no pre-existing tendency to depression14 or where only involuntary job losses (and not job losses due to health problems) were taken into account.10 Furthermore, significant associations with symptoms of depression have been found for economically inactive groups such as students, homemakers and voluntarily unemployed people, as well as for the long-term unemployed.19 Unemployment therefore has a negative effect on mental health above and beyond existing predisposition, and should be considered an independent risk factor for disorders such as depression. Its effects are also not entirely attributable to the stress of job loss or newly experienced financial strain.

Several theorists have considered what it is about unemployment which may induce CMD in those without jobs. Originally, it was hypothesized that the greatest impact of job loss on mental health was likely to be financial strain and poverty.5, 13, 20, 21 Until recent decades, unemployment of the main household earner would result in severe poverty, leading to other stressors such as debt, poor health and malnutrition.20, 21 However, more recently, the link between absolute poverty and unemployment has been lessened due to social benefit schemes for the unemployed. The association between unemployment and mental health problems remains, prompting theorists to speculate that work has psychological benefits for individuals beyond the receipt of sufficient income. Jahoda20 posited that employment has five positive psychological benefits: imposition of a time structure; increase in the scope of social experience; participation in a collective purpose; status and identity for the individual; and regular activity. Warr12 similarly suggested that there are several benefits of employment, including money, activity, variety, time structure, social contacts and a sense of identity. Without paid employment, a person’s behaviours and environment are likely to be restricted, as is their ability to make decisions,22 thus impacting on their mental health. In short, employment is conceptualized as offering psychological benefits above and beyond those gained from financial stability, and psychological deprivation occurs during periods of unemployment.

Not every unemployed person has the same risk of mental ill health. It has been found that men are at higher risk of depression during periods of unemployment than women,5, 6, 22 although single women and those who are the main wage earner have a similar response to unemployment as men.21, 22, 23 Age also appears to be a determining factor. Some evidence suggests that middle-aged men experience higher distress than men who are younger or older, and this may be associated with greater financial strain and family commitments among this age group.22

Duration of unemployment is also associated with risk of depression. The long-term unemployed have been found to have more episodes of depression.3 Well-being has been found to decline in young adults experiencing longer periods of unemployment.9, 24 However, other studies have found that there is adjustment by unemployed people to unemployment,17 with some evidence that mental health declines during the first 6 months of unemployment and stabilizes thereafter.12, 19, 22, 25 The effect of duration of unemployment on mental health is therefore unclear.

As noted above, in most developed societies, unemployed people can now claim welfare benefits to alleviate the financial strain of unemployment. The effect of the receipt of benefits on mental health is mixed. Financial strain and levels of activity act as mediating variables between unemployment and mental health problems,2, 5, 22 and debt has also been found to mediate between low income and mental health.26 Benefits may therefore protect the mental health of individuals by reducing financial strain and debt. Studies have compared the mental health of those who are unemployed with no benefits, unemployed with means-tested benefits, and unemployed with insurance-type benefits. Those in receipt of means-tested benefits are at similar risk of depression as those without benefits. Only individuals receiving insurance-type benefits have a lower risk of depression.27, 28, 29 These findings are likely to be confounded by the factors which determine the type of benefit that individuals receive. Those in receipt of means-tested benefits may have long-term exposure to material deprivation and may be at greater social disadvantage than those who are entitled to insurance-type benefits.28 More research is needed, therefore, to understand the protective role of benefits for mental health during unemployment, and to understand the effects of the UK system of benefits which is more complicated than in some other countries.

The current study used cross-sectional data to examine the different rates of CMD in different employment and benefit groups. For these analyses, unemployment was defined as those out of work who were looking for work, and economically inactive included those who were out of work for other reasons such as being a homemaker or a student. For the economically inactive, further detail about reasons for not working, such as poor physical health, not wanting or needing to work, or not working for other reasons (e.g. studying, maternity leave, looking after family/home), were available. It was hypothesized that CMD would be greater in unemployed and economically inactive individuals compared with the employed, and that receipt of unemployment benefit would be beneficial for CMD as it would attenuate the association between unemployment and financial strain. The association between self-employment and CMD, other types of welfare benefits and CMD, and length of unemployment and CMD were treated in an exploratory fashion. It was hypothesized that debt and income would explain associations observed between unemployment, benefits and CMD, and that gender would be a moderating factor in the association between unemployment and CMD, with associations being stronger in men than women.

Section snippets

Sample design

The Adult Psychiatric Morbidity Survey (APMS) 2007 is a stratified probability sample survey conducted among adults aged 16 years and over living in private households in England. Fieldwork took place between October 2006 and December 2007.

The survey had a random probability sampling design, using the small users’ postcode address file as a sampling frame. Approximately 14,500 addresses were selected. When interviewers visited the addresses, they established the eligible household occupants,

Results

Unadjusted logistic regressions showed that CMD was significantly more common in those currently out of work, whether they were unemployed or economically inactive, and in those not working due to physical health problems or because they were seeking work. Individuals who were self-employed had a lower rate of CMD than employees. Unemployed persons were at higher risk of CMD at all durations of unemployment, and the odds of CMD increased as the duration of unemployment increased (Table 2).

Discussion

The results of this study confirm that being out of work is associated with CMD. This was found to be true for those who were not seeking re-employment (the ‘economically inactive’) and for those who had been unemployed for a long time, suggesting that job loss events are not the only reason why unemployed people develop CMD. This association was not explained by the effects of unemployment on household income or debt. The state of unemployment itself may be detrimental to mental health, as

Ethical approval

Ethical approval for the Adult Psychiatric Morbidity Survey 2007 was obtained from the Royal Free Hospital and Medical School Research Ethics Committee (Ref. No. 06/Q0501/71).

Funding

The Adult Psychiatric Morbidity Survey 2007 was commissioned by the National Health Service Information Centre for Health and Social Care with funding from the Department of Health. This secondary analysis was funded by a grant from the Health and Safety Executive.

Competing interests

None declared.

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