Effects of poverty on mental health in the UK working-age population: causal analyses of the UK Household Longitudinal Study

Thomson, R. M. , Kopasker, D. , Leyland, A. , Pearce, A. and Katikireddi, S. V. (2023) Effects of poverty on mental health in the UK working-age population: causal analyses of the UK Household Longitudinal Study. International Journal of Epidemiology, 52(2), pp. 512-522. (doi: 10.1093/ije/dyac226) (PMID:36479855) (PMCID:PMC10114108)

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Background: Addressing poverty through taxation or welfare policies is likely important for public mental health; however, few studies assess poverty’s effects using causal epidemiology. We estimated the effect of poverty on mental health. Methods: We used data on working-age adults (25–64 years) from nine waves of the UK Household Longitudinal Survey (2009–19; n = 45 497/observations = 202 207 following multiple imputation). We defined poverty as a household equivalized income <60% median, and the outcome likely common mental disorder (CMD) as a General Health Questionnaire-12 score ≥4. We used double-robust marginal structural modelling with inverse probability of treatment weights to generate absolute and relative effects. Supplementary analyses separated transitions into/out of poverty, and stratified by gender, education, and age. We quantified potential impact through population attributable fractions (PAFs) with bootstrapped standard errors. Results: Good balance of confounders was achieved between exposure groups, with 45 830 observations (22.65%) reporting poverty. The absolute effect of poverty on CMD prevalence was 2.15% [%-point change; 95% confidence interval (CI) 1.45, 2.84]; prevalence in those unexposed was 20.59% (95% CI 20.29%, 20.88%), and the odds ratio was 1.17 (95% CI 1.12, 1.24). There was a larger absolute effect for transitions into poverty [2.46% (95% CI 1.56, 3.36)] than transitions out of poverty [–1.49% (95% CI –2.46, –0.53)]. Effects were also slightly larger in women than men [2.34% (95% CI 1.41, 3.26) versus 1.73% (95% CI 0.72, 2.74)]. The PAF for moving into poverty was 6.34% (95% CI 4.23, 8.45). Conclusions: PAFs derived from our causal estimates suggest moves into poverty account for just over 6% of the burden of CMD in the UK working-age population, with larger effects in women.

Item Type:Articles
Additional Information:This work was supported by the Wellcome Trust (218105/Z/19/Z and 205412/Z/16/Z), NHS Research Scotland (SCAF/15/02), Medical Research Council (MC_UU_00022/2), Chief Scientist Office (SPHSU17) and the European Research Council (949582).
Glasgow Author(s) Enlighten ID:Katikireddi, Professor Vittal and Kopasker, Dr Daniel and Leyland, Professor Alastair and Thomson, Dr Rachel and Pearce, Dr Anna
Authors: Thomson, R. M., Kopasker, D., Leyland, A., Pearce, A., and Katikireddi, S. V.
College/School:College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > MRC/CSO SPHSU
Journal Name:International Journal of Epidemiology
Publisher:Oxford University Press
ISSN (Online):1464-3685
Published Online:08 December 2022
Copyright Holders:Copyright © 2022 The Authors
First Published:First published in International Journal of Epidemiology 52(2):512-522
Publisher Policy:Reproduced under a Creative Commons licence

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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/ZSHW - MRC/CSO Social & Public Health Sciences Unit
174091Improving life chances & reducing child health inequalities: harnessing the untapped potential of existing dataAnna PearceWellcome Trust (WELLCOTR)205412/Z/16/ZSHW - MRC/CSO Social & 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/15/02SHW - Public Health
3048230021Inequalities in healthAlastair LeylandMedical Research Council (MRC)MC_UU_00022/2HW - MRC/CSO Social and Public Health Sciences Unit
3048230071Inequalities in healthAlastair LeylandOffice of the Chief Scientific Adviser (CSO)SPHSU17HW - MRC/CSO Social and Public Health Sciences Unit
308851HEEDSrinivasa KatikireddiEuropean Research Council (ERC)949582SHW - MRC/CSO Social & Public Health Sciences Unit