Thomson, R. M. , Kopasker, D. , Leyland, A. , Pearce, A. and Katikireddi, S. V. (2023) To what extent does income explain the effect of unemployment on mental health? Mediation analysis in the UK Household Longitudinal Study. Psychological Medicine, 53(13), pp. 6271-6279. (doi: 10.1017/S0033291722003580) (PMID:36453184) (PMCID:PMC10520578)
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Abstract
Background: Employment and income are important determinants of mental health (MH), but the extent that unemployment effects are mediated by reduced income is unclear. We estimated the total effect (TE) of unemployment on MH and the controlled direct effect (CDE) not acting via income. Methods: We included adults 25–64 years from nine waves of the UK Household Longitudinal Study (n = 45 497/obs = 202 297). Unemployment was defined as not being in paid employment; common mental disorder (CMD) was defined as General Health Questionnaire-12 score ≥4. We conducted causal mediation analysis using double-robust marginal structural modelling, estimating odds ratios (OR) and absolute differences for effects of unemployment on CMD in the same year, before (TE) and after (CDE) blocking the income pathway. We calculated percentage mediation by income, with bootstrapped standard errors. Results: The TE of unemployment on CMD risk was OR 1.66 (95% CI 1.57–1.76), with 7.09% (6.21–7.97) absolute difference in prevalence; equivalent CDEs were OR 1.55 (1.46–1.66) and 6.08% (5.13–7.03). Income mediated 14.22% (8.04–20.40) of the TE. Percentage mediation was higher for job losses [15.10% (6.81–23.39)] than gains [8.77% (0.36–17.19)]; it was lowest for those 25–40 years [7.99% (−2.57 to 18.51)] and in poverty [2.63% (−2.22 to 7.49)]. Conclusions: A high proportion of the short-term effect of unemployment on MH is not explained by income, particularly for younger people and those in poverty. Population attributable fractions suggested 16.49% of CMD burden was due to unemployment, with 13.90% directly attributable to job loss rather than resultant income changes. Similar analytical approaches could explore how this differs across contexts, by other factors, and consider longer-term effects.
| 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). |
| Status: | Published |
| Refereed: | Yes |
| Glasgow Author(s) Enlighten ID: | Katikireddi, Professor Vittal and Kopasker, Dr Daniel and Thomson, Dr Rachel and Leyland, Professor Alastair 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: | Psychological Medicine |
| Publisher: | Cambridge University Press |
| ISSN: | 0033-2917 |
| ISSN (Online): | 1469-8978 |
| Published Online: | 01 December 2022 |
| Copyright Holders: | Copyright © 2022 The Authors |
| First Published: | First published in Psychological Medicine 53(13): 6271–6279 |
| Publisher Policy: | Reproduced under a Creative Commons License |
| Related URLs: | |
| Data DOI: | 10.5255/UKDA-SN-6614-14 |
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