Which is most important for mental health: money, poverty, or paid work? A fixed-effects analysis of the UK Household Longitudinal Study

Kromydas, T., Thomson, R. M. , Pulford, A., Green, M. J. and Katikireddi, S. V. (2021) Which is most important for mental health: money, poverty, or paid work? A fixed-effects analysis of the UK Household Longitudinal Study. SSM - Population Health, 15, 100909. (doi: 10.1016/j.ssmph.2021.100909) (PMID:34584931) (PMCID:PMC8455855)

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Abstract

Background: The relative importance of income, poverty and unemployment status for mental health is unclear, and understanding this has implications for income and welfare policy design. We aimed to assess the association between changes in these exposures and mental health. Methods: We measured effects of three transition exposures between waves of the UK Household Longitudinal Study from 2010/11–2019/20 (n = 38,697, obs = 173,859): income decreases/increases, moving in/out of poverty, and job losses/gains. The outcome was General Health Questionnaire (GHQ), which measures likelihood of common mental disorder (CMD) as a continuous (GHQ-36) and binary measure (score ≥4 = case). We used fixed-effects linear and linear probability models to adjust for time invariant and time-varying confounders. To investigate effect modification, we stratified analyses by age, sex and highest education. Results: A 10% income decrease/increase was associated with a 0.02% increase (95% CI 0.00, 0.04) and 0.01% reduction (95% CI -0.03, 0.02) in likelihood of CMD respectively. Effect sizes were larger for moving into poverty (+1.8% [0.2, 3.5]), out of poverty (−1.8%, [-3.2, −0.3]), job loss (+15.8%, [13.6, 18.0]) and job gain (−11.4%, [-14.4, −8.4]). The effect of new poverty was greater for women (+2.3% [0.8, 3.9] versus +1.2% [-1.1, 3.5] for men) but the opposite was true for job loss (+17.8% [14.4, 21.2] for men versus +13.5% [9.8, 17.2] for women). There were no clear differences by age, but those with least education experienced the largest effects from poverty transitions, especially moving out of poverty (−2.9%, [-5.7, −0.0]). Conclusions: Moving into unemployment was most strongly associated with CMD, with poverty also important but income effects generally much smaller. Men appear most sensitive to employment transitions, but poverty may have larger impacts on women and those with least education. As the COVID-19 pandemic recedes, minimising unemployment as well as poverty is crucial for population mental health.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Pulford, Andrew and Thomson, Dr Rachel and Kromydas, Dr Theocharis and Green, Dr Michael
Authors: Kromydas, T., Thomson, R. M., Pulford, A., Green, M. J., and Katikireddi, S. V.
College/School:College of Medical Veterinary and Life Sciences > Institute of Health and Wellbeing > MRC/CSO SPHSU
Journal Name:SSM - Population Health
Publisher:Elsevier
ISSN:2352-8273
ISSN (Online):2352-8273
Published Online:04 September 2021
Copyright Holders:Copyright © 2021 The Authors
First Published:First published in SSM - Population Health 15: 100909
Publisher Policy:Reproduced under a Creative Commons License

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Project CodeAward NoProject NamePrincipal InvestigatorFunder's NameFunder RefLead Dept
306430Predicting the impacts of universal basic income on mental health inequalities in the UK population: a microsimulation modelRachel ThomsonWellcome Trust (WELLCOTR)218105/Z/19/ZHW - MRC/CSO Social and Public Health Sciences Unit
172690Understanding the impacts of welfare policy on health: A novel data linkage studySrinivasa KatikireddiOffice of the Chief Scientific Adviser (CSO)SCAF/15/02HW - Public Health
Inequalities in healthMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
Office of the Chief Scientific Adviser (CSO)SPHSU17
308851HEEDSrinivasa KatikireddiEuropean Research Council (ERC)949582HW - MRC/CSO Social and Public Health Sciences Unit
311928Assessing the impacts of economic policy responses to the COVID-19 pandemic on mental health: A microsimulation modelling studySrinivasa KatikireddiThe Health Foundation (HEALFOU)2135162HW - MRC/CSO Social and Public Health Sciences Unit