Effects of Psychiatric Disorders on Labor Market Outcomes: A Latent Variable Approach Using Multiple Clinical Indicators

Impact of heat on mental health emergency visits: a time series study from all public emergency centres, in Curitiba, Brazil

OBJECTIVES

Quantify the risk of mental health (MH)-related emergency department visits (EDVs) due to heat, in the city of Curitiba, Brazil.

DESIGN

Daily time series analysis, using quasi-Poisson combined with distributed lag non-linear model on EDV for MH disorders, from 2017 to 2021.

SETTING

All nine emergency centres from the public health system, in Curitiba.

PARTICIPANTS

101 452 EDVs for MH disorders and suicide attempts over 5 years, from patients residing inside the territory of Curitiba.

MAIN OUTCOME MEASURE

Relative risk of EDV (RREDV) due to extreme mean temperature (24.5°C, 99th percentile) relative to the median (18.02°C), controlling for long-term trends, air pollution and humidity, and measuring effects delayed up to 10 days.

RESULTS

Extreme heat was associated with higher single-lag EDV risk of RREDV 1.03(95% CI 1.01 to 1.05-single-lag 2), and cumulatively of RREDV 1.15 (95% CI 1.05 to 1.26-lag-cumulative 0-6). Strong risk was observed for patients with suicide attempts (RREDV 1.85, 95% CI 1.08 to 3.16) and neurotic disorders (RREDV 1.18, 95% CI 1.06 to 1.31). As to demographic subgroups, females (RREDV 1.20, 95% CI 1.08 to 1.34) and patients aged 18-64 (RREDV 1.18, 95% CI 1.07 to 1.30) were significantly endangered. Extreme heat resulted in lower risks of EDV for patients with organic disorders (RREDV 0.60, 95% CI 0.40 to 0.89), personality disorders (RREDV 0.48, 95% CI 0.26 to 0.91) and MH in general in the elderly ≥65 (RREDV 0.77, 95% CI 0.60 to 0.98). We found no significant RREDV among males and patients aged 0-17.

CONCLUSION

The risk of MH-related EDV due to heat is elevated for the entire study population, but very differentiated by subgroups. This opens avenue for adaptation policies in healthcare: such as monitoring populations at risk and establishing an early warning systems to prevent exacerbation of MH episodes and to reduce suicide attempts. Further studies are welcome, why the reported risk differences occur and what, if any, role healthcare seeking barriers might play.

Lasting scars: The impact of depression in early adulthood on subsequent labor market outcomes

A growing body of evidence indicates that poor health early in life can leave lasting scars on adult health and economic outcomes. While much of this literature focuses on childhood experiences, mechanisms generating these lasting effects-recurrence of illness and interruption of human capital accumulation-are not limited to childhood. In this study, we examine how an episode of depression experienced in early adulthood affects subsequent labor market outcomes. We find that, at age 50, people who had met diagnostic criteria for depression when surveyed at ages 27-35 earn 10% lower hourly wages (conditional on occupation), work 120-180 fewer hours annually, and earn 24% lower annual wage incomes. A portion of this income penalty (21%-39%) occurs because depression is often a chronic condition, recurring later in life. But a substantial share (25%-55%) occurs because depression in early adulthood disrupts human capital accumulation, by reducing work experience and by influencing selection into occupations with skill distributions that offer lower potential for wage growth. These lingering effects of early depression reinforce the importance of early and multifaceted intervention to address depression and its follow-on effects in the workplace.

Causal effects of mental health on food security

Although mental health conditions are known to be associated with socioeconomic hardships, their causal effects remain largely unexplored. Using a sample of low-income families in the National Health Interview Survey (NHIS), we assess causal effects of serious mental illness (SMI) and related mental health conditions on family food security. We apply partial identification methods to account for fundamental endogeneity and measurement identification problems in a unified framework. To implement these methods, we combine a proxy measure of SMI in the NHIS with an estimate of the true rate of SMI from the Substance Abuse and Mental Health Services Administration. We also develop an innovative approach to approximate true prevalence rates when only self-reported prevalence rates are available. Applying relatively weak monotonicity assumptions on latent food security outcomes, we find that alleviating SMI would improve the food security rate by at least 9.5 percentage points, or 15 %. JEL codes: C21, I10, I38.

Evictions and psychiatric treatment

Stable housing is critical for health, employment, education, and other social outcomes. Evictions reflect a form of housing instability that is experienced by millions of Americans each year. Inadequately treated psychiatric disorders have the potential to influence evictions in several ways. For example, these disorders may impede labor market performance and thus the ability to pay rent, or increase the likelihood of risky and/or nuisance behaviors that can lead to a lease violation. We estimate the effect of local access to psychiatric treatment on eviction rates. We combine data on the number of psychiatric treatment centers that offer outpatient and residential care within a county with eviction rates in a two-way fixed-effects framework. Our findings imply that 10 additional psychiatric treatment centers in a county lead to a reduction of 2.1% in the eviction rate.

Mental health and labor supply: Evidence from Canada

This study investigates the relationship between mental health and employment using an instrumental variable approach with the 2012 Canadian Community Health Survey-Mental Health. Using a family member's mental health problem(s) as an instrument for poor mental health, the estimates reveal that poor mental health significantly reduces employment outcomes. These findings are robust to various specifications, such as an alternative instrument and a relaxation of the exclusion restriction assumption. In addition, the relationship is driven mainly by men and younger workers. Moreover, the findings suggest that the relationship is mediated by a decline in cognitive abilities, such as difficulties in concentration and motivation, and social relations with acquaintances and friends. Finally, the estimates show that this phenomenon is contagious: poor mental health has a significant spillover effect on coworkers' mental health in workplaces. This study demonstrates the importance of mental health illness in Canada and other developed countries.

Examination of Adaptations to the Evidence Based Supported Employment Model: Individual Placement and Support

Individual Placement and Support (IPS) is a long-standing and innovative employment service for individuals with mental illness with dozens of clinical trials demonstrating effectiveness. Little is known, however, about intentional adaptations to IPS, especially those outside of the context of research studies. Using an implementation science framework, we conducted an exploratory study to better understand the characteristics of stakeholder-reported adaptions to IPS, the impetus for their development, and perceived impacts. We conducted qualitative interviews to analyze and describe these adaptations. Numerous adaptations of IPS were found that address the needs of new and underserved populations both within and outside of the mental health field. Programs reported adapting IPS because of the dearth of other evidence-based employment services, to serve diverse populations in need, and based on financial incentives. Benefits of adaptations were weighed against impacts on fidelity. As evidence-based practices (EBPs) are adapted, developers of EBPs should determine how fidelity of a program or service can be assessed or preserved in light of adaptations. This is critical with the increase in different service delivery methods, new populations, new service recipient needs, and new settings in need of EBPs.

Pain and labor outcomes: A longitudinal study of adults with cerebral palsy in Sweden

BACKGROUND

Pain is a global health concern with substantial societal costs and limits the activity participation of individuals. The prevalence of pain is estimated to be high among individuals with cerebral palsy (CP).

OBJECTIVES

To estimate the association between pain and labor outcomes for adults with CP in Sweden.

METHODS

A longitudinal cohort study based on data from Swedish population-based administrative registers of 6899 individuals (53,657 person-years) with CP aged 20-64 years. Individual fixed effects regression models were used to analyze the association between pain and labor outcomes (employment and earnings from employment), as well as potential pathways through which pain might affect employment and earnings.

RESULTS

Pain was associated with adverse outcomes varying across severity, corresponding to a reduction of 7-12% in employment and 2-8% in earnings if employed. Pain might affect employment and earnings through increased likelihood of both sickness leave and early retirement.

CONCLUSION

Pain management could potentially be important to improve labor outcomes for adults with CP, in addition to improving the quality of life.

The financial situation before and after first-time psychiatric in-patient diagnosis of schizophrenia spectrum, bipolar, and major depressive disorder

Schizophrenia spectrum, bipolar, and major depressive disorders are severe mental illnesses (SMIs) that not only entail great suffering for those affected but also major societal costs. In this study, I use administrative register data to provide a detailed picture of the financial situation of people with SMI in Sweden during a period of ±10 years around first-time psychiatric in-patient diagnosis of schizophrenia spectrum, bipolar, and major depressive disorders. Receiving a diagnosis was associated with a considerable drop in earnings, which was largely compensated for by social transfers: mainly sickness and disability insurance. However, there were also large and increasing pre-diagnosis earnings gaps, relative to matched comparison groups, especially among those with schizophrenia spectrum disorders. These gaps were to a lesser extent compensated for by social transfers. Consequently, there were permanent and increasing - due to lost earnings growth - income differentials. Hence, findings in previous studies are confirmed: even in an advanced welfare state, people with SMI - especially those with schizophrenia - have an extremely weak position on the labour market and an equally difficult financial situation.

The Role of Mental Health on Workplace Productivity: A Critical Review of the Literature

BACKGROUND

Mental health disorders in the workplace have increasingly been recognised as a problem in most countries given their high economic burden. However, few reviews have examined the relationship between mental health and worker productivity.

OBJECTIVE

To review the relationship between mental health and lost productivity and undertake a critical review of the published literature.

METHODS

A critical review was undertaken to identify relevant studies published in MEDLINE and EconLit from 1 January 2008 to 31 May 2020, and to examine the type of data and methods employed, study findings and limitations, and existing gaps in the literature. Studies were critically appraised, namely whether they recognised and/or addressed endogeneity and unobserved heterogeneity, and a narrative synthesis of the existing evidence was undertaken.

RESULTS

Thirty-eight (38) relevant studies were found. There was clear evidence that poor mental health (mostly measured as depression and/or anxiety) was associated with lost productivity (i.e., absenteeism and presenteeism). However, only the most common mental disorders were typically examined. Studies employed questionnaires/surveys and administrative data and regression analysis. Few studies used longitudinal data, controlled for unobserved heterogeneity or addressed endogeneity; therefore, few studies were considered high quality.

CONCLUSION

Despite consistent findings, more high-quality, longitudinal and causal inference studies are needed to provide clear policy recommendations. Moreover, future research should seek to understand how working conditions and work arrangements as well as workplace policies impact presenteeism.

Excess healthcare costs of psychological distress in young women: Evidence from linked national Medicare claims data

The prevalence of mental health disorders in young adults is increasing, yet there is limited empirical evidence on its economic consequences. We contribute to the literature by estimating the healthcare costs of psychological distress using panel data of young women (aged 18-23 years with a 5-year follow-up) from the Australian Longitudinal Study on Women's Health and linked administrative data from Medicare Australia. Our empirical strategy is based on the classical two-part model of healthcare costs with individual specific fixed-effects. We complement our analysis with a test for selection on unobservables to address potential concerns of endogeneity. We find that young women with psychological distress have 15% higher annual healthcare costs (excluding hospital costs) than women with no psychological distress. A large proportion of these costs is driven by the use of antidepressants and the services of psychiatrists and psychologists. We further find that women with psychological distress have higher out-of-pocket costs on these mental health related services compared to non-mental health specific services. Additionally, we show that the effect of psychological distress on healthcare costs is highest during the first 6 months of onset, which gradually decreases afterwards. The findings justify the importance of policy initiatives towards early prevention and treatment of psychological distress, especially among young women.

The linkage of depressive and anxiety disorders with the expected labor market affiliation (ELMA): a longitudinal multi-state study of Danish employees

OBJECTIVE

Depressive and anxiety disorders are prevalent among employees in general. Still, knowledge regarding the contribution of these disorders to the dynamics of the labor market in terms of working time, sickness absence, and unemployment is scarce. We aim to quantify the linkage of depressive and anxiety disorders with labor market participation using the expected labor market affiliation method (ELMA), in a large sample of Danish employees.

METHODS

We combined three survey waves on occupational health with six high-quality national registers in N = 43,148 Danish employees, of which the 2012 survey contributed 29,665 person years, the 2014 survey 33,043 person years, and the 2016 survey 35,375 person years. We used the new ELMA method to estimate the multi-state transition probabilities and 2-year expected time in work, sickness absence, and unemployment. Depressive and anxiety disorders were assessed by the Major Depression Inventory and the SCL-ANX4 scales, respectively. We adjusted for multiple variables by applying inverse probability weighting in groups of gender and age.

RESULTS

Depressive and anxiety disorders among employees link to reduced labor market affiliation by significantly changed transitions probabilities between the labor markets states, viewed as reduced working time by 4-51 days (in two years), increased time in sickness absence by 6-44 days (in two years), and unemployment by 6-12 days (in two years) when compared to employees without depression or anxiety disorders. The results were most pronounced for women employees and for employees with both depression and anxiety disorders.

CONCLUSIONS

The study reveals detailed insight into what extent depression and anxiety disorders influence the labor market affiliation, in terms of the complex interrelation between working time, sickness absence, and unemployment. The study emphasizes the importance of preventing and handling depressive and anxiety disorders among employees for strengthening work participation.

Maternal genetic risk for depression and child human capital

We here address the causal relationship between the maternal genetic risk for depression and child human capital using UK birth-cohort data. We find that an increase of one standard deviation (SD) in the maternal polygenic risk score for depression reduces their children's cognitive and non-cognitive skill scores by 5 to 7% of a SD throughout adolescence. Our results are robust to a battery of sensitivity tests addressing, among others, concerns about pleiotropy and dynastic effects. Our Gelbach decomposition analysis suggests that the strongest mediator is genetic nurture (through maternal depression itself), with genetic inheritance playing only a marginal role.

Parallel latent trajectories of mental health and personal earnings among 16- to 20 year-old US labor force participants: a 20-year longitudinal study

PURPOSE

Determine the number of latent parallel trajectories of mental health and employment earnings over two decades among American youth entering the workforce and estimate the association between baseline sociodemographic and health factors on latent trajectory class membership.

METHODS

This study used data of 8173 participants from the National Longitudinal Survey of Youth 1997 who were 13-17 years old in 1997. Surveys occurred annually until 2011 then biennially until 2017, when participants were 33-37 years old. The Mental Health Inventory-5 measured mental health at eight survey cycles between 2000 and 2017. Employment earnings were measured annually between 1998 and 2017. Latent parallel trajectories were estimated using latent growth modeling. Multinomial logistic regression explored the association between baseline factors and trajectory membership.

RESULTS

Four parallel latent classes were identified; all showed stable mental health and increasing earnings. Three percent of the sample showed a good mental health, steep increasing earnings trajectory (average 2017 earnings ~ $196,000); 23% followed a good mental health, medium increasing earnings trajectory (average 2017 earnings ~ $78,100); 50% followed a good mental health, low increasing earnings trajectory (average 2017 earnings ~ $39,500); and 24% followed a poor mental, lowest increasing earnings trajectory (average 2017 earnings ~ $32,000). Participants who were younger, women, Black or Hispanic, from lower socioeconomic households, and reported poorer health behaviors had higher odds of belonging to the poor mental health, low earnings class.

CONCLUSION

Findings highlight the parallel courses of mental health and labor market earnings, and the influence of gender, race/ethnicity, and adolescent circumstances on these processes.

COVID-19 and entrepreneurship entry and exit: Opportunity amidst adversity

We theoretically and empirically examine how acquiring new skills and increased financial worries influenced entrepreneurship entry and exit intentions during the pandemic. To that end, we analyze primary individual-level survey data we collected in the aftermath of the COVID-19's first wave in Russia, which has had one of the highest COVID-19 infection rates globally. Our results show that acquiring new skills during the pandemic helped owners keep their existing businesses and encouraged start-ups in sectors other than information technology (IT). For IT start-ups, having previous experience matters more than new skills. While the pandemic-driven financial worries are associated with business closure intentions, they also inspire new business start-ups, highlighting the pandemic's creative destruction power. Furthermore, preferences for formal employment and remote work also matter for entrepreneurial intentions. Our findings enhance the understanding of entrepreneurship formation and closure in a time of adversity and suggest that implementing entrepreneurship training and upskilling policies during recurring waves of the COVID-19 pandemic can be an important policy tool for innovative small business development.

When Non-Compliance Carries the Day: Evaluating the Effectiveness of an Employment Program for the Severely Mentally Ill

Mental disease is increasing worldwide and people who suffer from it show lower employment rates and lower earnings. Various approaches have been tried to increase the employment rate of people with mental disease. In the US, empirical studies show that individual placement and support(IPS)-a rapid transition to the job market, with some external assistance-is effective in increasing the employment rate of the mentally ill. Europe lacks such evidence. The study assesses the impact of an IPS-like program undertaken in Italy on the employment rate of people with severe mental illness. The analysis is based on a RCT that tests whether offering people with severe mental illness the support of a "job coach" increases their chances of being employed. Moreover, using a battery of tests-one of which is made available by the RCT itself-we show that the large non-compliance with the protocol showed by the RCT is ignorable. This motivates estimating the impact of carrying out a traineeship during the experimental period on employment using non-experimental methods. The study finds that the availability of a coach boosts the patients' chances of finding a traineeship during the experimental period; moreover, undertaking a traineeship almost doubles the likelihood of being at work one year later.JEL CODES: J78, J48, J38.

Feasibility of Work-Related Interviewing and Conversational Skills Trainings for Individuals With Psychiatric Disabilities

This study examined the feasibility of group interventions using the Direct Skills Teaching (DST) approach to teach interview preparedness skills (“Presenting Qualifications”) and basic work-related conversational skills (“Conversing with Others”) to individuals with psychiatric disabilities. This quasi-experimental pilot study included 87 participants in Study 1 and 55 participants in Study 2, all with various psychiatric diagnoses. Each group intervention consisted of four sessions delivered by graduate counseling students. Participants reported increased confidence in presenting qualifications at interviews in Study 1, and in conversational skills at work in Study 2. Participants in both studies reported high levels of satisfaction with the respective group intervention. The results of the study supported the feasibility of DST group interventions designed to teach work-related skills to individuals with psychiatric disabilities.

Depression and labor supply: Evidence from the Netherlands

We estimate the relationship between depression and labor-market outcomes using data from the Longitudinal Internet studies for the Social Sciences (LISS) panel (2008 - 2018) from the Netherlands. The paper provides three main findings. First, depression is not associated with women's labor market participation, but it is associated with their likelihood of having paid employment (conditional on being in the labor force). Second, depression is associated with men's labor force participation, likelihood of having paid employment and likelihood of working full time. Third, severity of depression matters. More severe symptoms are associated with more adverse labor-market outcomes. In addition, we examine the mechanism behind the relationship between depression and labor market outcomes. We find that happiness, life satisfaction, and pessimistic beliefs about the future are partially mediating the effects.

Adolescent depression and adult labor market marginalization: a longitudinal cohort study

Adolescent depression is linked to adult ill-health and functional impairment, but recent research suggests that individual/contextual factors might account for this association. This study aimed to test whether the clinical heterogeneity of adolescent depression is related to marginalization from the labor market across early to middle adulthood. Data were drawn from the Uppsala Longitudinal Adolescent Depression Study, a community-based cohort initially assessed with structured clinical interviews at age 16-17. The cohort (n = 321 depressed; n = 218 nondepressed) was followed up after 2+ decades through linkage to nationwide population-based registries. Outcomes included consecutive annual data on unemployment, work disability, social welfare recipiency, and a composite marginalization measure, spanning from age 21 to 40. Longitudinal associations were examined using logistic regression analysis in a generalized estimating equations modeling framework. Subsequent depressive episodes and educational attainment in early adulthood were explored as potential pathways. The results showed that adolescent depression was associated with adult marginalization outcomes, but the strength of association varied across depressed subgroups. Adolescents with persistent depressive disorder had higher odds of all outcomes, including the composite marginalization measure (adjusted OR = 2.0, 95% CI = 1.4-2.7, p < 0.001), and this was partially (31%) mediated by subsequent depressive episodes in early adulthood. Exploratory moderation analysis revealed that entry into tertiary education mitigated the association with later marginalization, but only for adolescents with episodic major depression. In conclusion, the risk for future labor market marginalization is elevated among depressed adolescents, particularly those presenting with persistent depressive disorder. Targeted interventions seem crucial to mitigate the long-lasting impact of early-onset depression.

How Do Adults with Autism Spectrum Disorder Participate in the Labor Market? A German Multi-center Survey

International studies show disadvantages for adults with autism spectrum disorder (ASD) in the labor market. Data about their participation in the German labor market are scarce. The aim of this study was to examine the integration of adults with ASD in the German labor market in terms of education, employment and type of occupation by means of a cross-sectional-study, using a postal questionnaire. Findings show above average levels of education for adults with ASD compared to the general population of Germany and simultaneously, below average rates of employment and high rates of financial dependency. That indicates a poor integration of adults with ASD in the German labor market and emphasizes the need for vocational support policies for adults with ASD.

Instrumental variable-based assessment of the effect of psychotherapy on suicide attempts, health, and economic outcomes in schizophrenia

The literature on the effect of psychotherapy for schizophrenia is limited and characterized by small samples and possible bias from risk selection. We examined the effects of psychotherapy on suicide attempts and health and economic outcomes using an instrumental variable (IV) approach that exploits the variation in the propensities of hospital departments to prescribe psychotherapy. This was supplemented with naïve probit models as exogeneity could not be ruled out for all of the outcomes. The validity of the instrument was examined by distributional plots and various tests. The assumed randomness in referring patients to providers with high versus low propensities to psychotherapy appeared to be a critical aspect. Splitting the sample into homogeneous provider types did not substantially alter the results. Based on the IV results, we found no support for the effect of psychotherapy on suicide attempt, psychiatric readmission, assisted living, or labor market attachment. However, we cannot rule out smaller effects due to confidence intervals including the probit estimates. The main contribution of this study is new evidence on a broad range of outcomes and a large and representative population.

Estimating Endogenous Treatment Effects Using Latent Factor Models with and without Instrumental Variables

We provide evidence on the least biased ways to identify causal effects in situations where there are multiple outcomes that all depend on the same endogenous regressor and a reasonable but potentially contaminated instrumental variable that is available. Simulations provide suggestive evidence on the complementarity of instrumental variable (IV) and latent factor methods and how this complementarity depends on the number of outcome variables and the degree of contamination in the IV. We apply the causal inference methods to assess the impact of mental illness on work absenteeism and disability, using the National Comorbidity Survey Replication.

The effect of mental health on social capital: An instrumental variable analysis

Although a large body of literature has examined the effect of social capital on health and theoretical models suggest a reciprocal relationship between the two variables, there are relatively few studies that have investigated the effect of mental health on social capital. This paper evaluates the impact of mental health on the stock of social capital using data from the cross-sectional 2012 (N = 21,844) and 2002 (N = 31,089) Canadian Community Health Survey - Mental Health editions. Mental health was measured retrospectively as self-rated mental health, past year mental health conditions, and past 30-day psychological distress. Given the reciprocal relationship, we used an instrumental variable approach with family history of mental health problems as the instrument and examined forms of social capital - sense of belonging and workplace social support - that are largely measures of social capital provided by non-family members in the community and workplace. The analysis suggests there are large and significant associations between measures of mental health and both outcomes, which persist in the instrumental variable analyses. These findings highlight the urgent need for policy makers to implement greater prevention and treatment of poor mental health, and provide greater support for individuals with poor mental health so they can build and maintain their social capital.

Incidence of catastrophic healthcare expenditure and its main determinants in Mexican households caring for a person with a mental disorder

BACKGROUND

There are few studies on the impact of out-of-pocket mental health care expenditures and sociodemographic factors on the probability of Mexican households to incur catastrophic healthcare expenditures (CHE).

OBJECTIVE

The goal of the present study was to estimate the incidence of CHE and its main determinants among the households of persons with mental disorders (MD) in Mexico.

METHODS

A cross-sectional survey was conducted, including 387 households of persons with MD. The estimation of the CHE was obtained by the health expenditure distribution method. A Logistic Regression (LR) was used to identify the determinants of probability variation of CHE occurrence. Since we expected a proportion of CHE between 20% and 80%, we assume linearity in the probability function, therefore we additionally used an Ordinary Least Squares (OLS) model.

RESULTS

In our sample, the incidence of CHE was 34.8%. The two mental illnesses most frequently associated with CHE were schizophrenia and hyperactive disorder (35.5% and 32.6% of CHE cases, respectively). The regression coefficients showed that for each unit (US$53.77) increase in income, the probability of CHE was reduced by 8.6%, while for each unit increase in hospitalization or medication expenditures, the probability of CHE increased by 12.9% or 19%, respectively. For each additional household member, the probability of CHE increased by 3%, and households with a male patient had a 7% greater probability of CHE.

CONCLUSION

Household income, household size, hospitalization and medication expenses, and sex of the patient were significant predictors of CHE for households caring for a person with MD.

No gain in pain: psychological well-being, participation, and wages in the BHPS

Accounting for endogeneity, unobserved heterogeneity, and sample selection in an unified framework, we investigate the effect of psychological well-being on wages and labour market participation using a panel from the British Household Panel Survey. We find the effect of psychological well-being on labour market outcomes to differ across gender. In particular, psychological distress significantly reduces participation across genders, but, conditional on participation, has a significant negative effect on hourly wages only in the female sample.

Employment Vulnerability of People With Severe Mental Illness

Using French longitudinal register data, we compare the evolution of employment rates of persons with severe chronic mental illness, before and after the first medico-administrative recognition of the illness by the Statutory Health Insurance (SHI), with that of people without recognised mental illness. The study focuses on persons of working age having a work history before recognition. Our empirical approach relies on a double difference method with coarsened exact matching. Before illness recognition subjects had lower employment rates than those without mental illness but relatively high, reflecting their initial employment attachment. Results indicate that employment rates decrease sharply after recognition. A large employment rate gap between persons with and without severe mental illness develops during the four years following recognition. We examine whether the magnitude of the decrease is sensitive to the macroeconomic context. Findings show that the decline in employment rates was significantly more pronounced during the Great Recession compared with the pre-crisis period, amongst women. As a conclusion, this study points out that implementing coordinated early health and labour policies in the phase of the entry into the chronic-illness insurance scheme of the SHI might play a key role in preventing the detrimental effects of illness on economic and social conditions of persons with severe mental illnesses.

Employment and earnings trajectories before and after sickness absence due to major depressive disorder: a nationwide case-control study

OBJECTIVES

To examine employment and earnings trajectories before and after the first sickness absence period due to major depressive disorder (MDD).

METHODS

All individuals (n=158 813) in Finland who had a first sickness absence period (lasting longer than 9 days) due to MDD between 2005 and 2015 were matched with one randomly selected individual of the same age and gender with no history of MDD. Employment status and earnings were measured using register-based data annually from 2005 to 2015. Generalised estimating equations were used to examine the trajectories of employment and earnings before and after MDD diagnosis in men and women separately.

RESULTS

Sickness absence due to MDD was associated with increased probability of non-employment during and after the year of the first sickness absence period. In men, but not in women, the probability of being employed was lower 5 years before the sickness absence period due to MDD. When compared with the individuals in the control group, men had around 34% and women 15% lower earnings 1 year, and 40% and 23%, respectively, 5 years, after the first sickness absence period due to MDD. More severe MDD and longer duration of sickness absence period were associated with lower probability of being employed.

CONCLUSIONS

Sickness absence due to MDD was associated with considerable reduction in employment and earnings losses. For men and individuals with more severe MDD, this reduction was before the first sickness period. This supports a reciprocal association between employment and earnings with MDD.

Heterogeneity in the associations between common mental disorders and labour outcomes - a population study from southern Sweden

Background

Previous research has shown that Common Mental Disorders (CMD) are unequally distributed between population subgroups, but we know less about how labour outcomes following such disorders are distributed. Our aim is to investigate how the labour outcomes following a CMD diagnosis differ over sex, age, schooling and country of birth.

Methods

We use a population sample from southern Sweden of patients diagnosed with CMD during calendar years 2009–2011, and a matched general population control group, to study labour market outcomes three years following diagnosis. Logistic regression is used to study the associations between a CMD diagnosis and outcomes in employment, sick leave, and disability pension. Interaction analysis is used to study heterogeneity in these associations.

Results

CMD diagnosis is associated with reduced employment and increased odds of sick leave and disability pension. Following a CMD diagnosis, men and higher educated individuals have higher odds of non-employment and sick leave compared to women and the lower educated. Foreign-born individuals have higher odds of non-employment and lower odds of sick leave, compared to individuals born in Sweden. Heterogeneity appears to be present also based on age. Younger age is associated with higher odds of non-employment and disability pension and lower odds of sick leave, following a CMD diagnosis.

Conclusions

Heterogeneity in labour outcomes following a CMD diagnosis sometimes contributes to and sometimes mitigates inequalities in employment, sick leave and disability pension between population subgroups. When developing new strategies to tackle mental ill-health in the population, it may therefore be motivated to consider not only inequalities in the prevalence of mental disorders but also heterogeneity in associated adverse labour outcomes.

The impact of leprosy on the mental wellbeing of leprosy-affected persons and their family members - a systematic review

Leprosy has long-term consequences related to impairment and stigma. This includes a major impact on mental health. This study aims to consolidate current evidence regarding the mental health impact of leprosy on affected persons and their family members. In addition, determinants influencing mental health outcomes among leprosy-affected persons and effective interventions are examined. A keyword-based search was conducted in PubMed, Web of Science, Scopus, PsycINFO, Infolep and InfoNTD; additional literature was also considered. Articles presenting primary data involving leprosy-affected persons or their family members experiencing mental conditions were included. Independent extraction of articles was executed using predefined data fields. Articles were sorted according to relevance. In total, 65 studies were included in this systematic review. Multiple psychiatric morbidities have been identified among leprosy-affected persons, including depression, anxiety disorders and suicide (attempts). Additional factors were found that may impact mental health. Moreover, studies found that demographic factors, lifestyle and disease-specific factors and stigma and discrimination impact mental health. Depressive symptoms and low self-esteem were identified among children of leprosy-affected persons. In addition, interventions were identified that could improve the mental wellbeing of leprosy patients. Depressive disorders and anxiety disorders were found to be very common among persons affected by leprosy. Feelings such as fear, shame and low self-esteem are also experienced by those affected, and their children. Further research is necessary to ensure that mental health impact is included when determining the burden of disease for leprosy, and to relieve this burden.

Working with a Severe Mental Illness: Estimating the Causal Effects of Employment on Mental Health Status and Total Mental Health Costs

Employment is an important goal for persons who have a severe mental illness (SMI). The current literature finds some evidence for a positive relationship between employment and measures of mental health (MH) status, however study design issues have prevented a causal interpretation. This study aims to measure the causal effect of employment on MH status and total MH costs for persons with SMI. In a quasi-experimental prospective design, self-reported data measured at baseline, 6-months, and 12-months, on MH status and employment are paired with Public Mental Health System (PMHS) claims data. The study population (N = 5162) is composed of persons with a SMI who received PMHS services for a year or more. Outcome variables are MH status symptom scores from the BASIS-24 instrument and total MH costs. The estimation method is full information maximum likelihood, which allows for tests of employment endogeneity. Outcomes with an insignificant test of endogeneity are estimated using tobit or ordinary least square (OLS). Employment has modest but meaningful effects on MH status (including overall MH status, functioning, and relationships) and reduces total mental health costs on average by $538 in a 6-month period. Tests of endogeneity were largely insignificant, except for the depression score that tested marginally statistically significant. Interaction terms between baseline MH scores and employment indicated larger employment effects for individuals with worse baseline scores. This study demonstrates the non-vocational benefits of employment for individuals with SMI. Results have high generalizability and should be of interest to federal and state governments in setting appropriate disability policy and funding vocational programs. From a methodological perspective, future research should still be concerned with potential endogeneity problems, especially if employment status and MH outcomes are simultaneously measured and/or baseline measures of MH are not adequately controlled for future research should continue to examine the multi-dimensional nature of MH status and costs. Our analyses also demonstrate the practical use of a state-wide outcomes measurement program in assessing the factors that influence the recovery trajectories of individuals with SMI.

The kids are alright - labour market effects of unexpected parental hospitalisations in the Netherlands

Unexpected negative health shocks of a parent may reduce adult children's labour supply via informal caregiving and stress-induced mental health problems. We link administrative data on labour market outcomes, hospitalisations and family relations for the full Dutch working age population for the years 1999-2008 to evaluate the effect of an unexpected parental hospitalisation on the probability of employment and on conditional earnings. Using an event study difference-in-differences model combined with coarsened exact matching and individual fixed effects, we find no effect of an unexpected parental hospitalisation on either employment or earnings for Dutch men and women, and neither for the full population nor for the subpopulations most likely to become caregivers. These findings suggest that the extensive public coverage of formal long-term care in the Netherlands combined with widespread acceptance of part-time work provides sufficient opportunities to deal with adverse health events of family members without having to compromise one's labour supply.

Predictors of Sustained Employment Among Individuals With Serious Mental Illness: Findings From a 5-Year Naturalistic Longitudinal Study

Despite decades of research, understanding of the employment trajectories of individuals with serious mental illnesses remains elusive. We conducted a 5-year prospective, longitudinal study using a geographically broad sample of individuals who met established criteria for sustained competitive employment (N = 529). We collected data on an annual basis with a specifically designed survey instrument. Despite stable employment at study entry, more than half of the participants experienced work interruptions during the 5-year follow-up period. Predictors of sustained employment included the absence of a trauma diagnosis, Social Security disability income, psychiatric hospitalizations, and difficulties with daily functioning. The presence of a higher quality of life, workplace supports, and a flexible job were also predictive. Results dispel the myth that people with serious mental illnesses cannot be employed for prolonged periods. Interruptions in work trajectories, however, suggest that longer-term supports may increase individuals' capacity to maintain stable employment.

"Do I look fat?" Self-perceived body weight and labor market outcomes

Research reporting that greater body weight is associated with lower wages and employment, particularly among women, focuses on how employers perceive workers. In contrast, we examine whether workers' own perceptions of body weight influence labor market outcomes. Numerous studies find that misperception of body weight influences health behaviors and health, both mental and physical. For example, anorexia nervosa involves the over-perception of weight and raises the risk of cardiovascular disease. Do the health consequences of inaccurate self-perceived weight carry through to the labor market? We use the National Longitudinal Survey of Youth 1997 (NLSY97) to investigate patterns in weight misperception and three labor market outcomes. We find little evidence that either over-perception or under-perception of weight is associated with wages, weeks worked, or the number of jobs held for women and men.

Contemporary Data and Trends in the Economic Costs of Mental Disabilities

This article addresses the economic effects of mental disabilities by analyzing contemporary data in the context of micro- and macroeconomic thought and relevant statistical literature. Within the parameters of these conceptual and statistical reference points, the authors seek to discern current trends in the direct, indirect, and opportunity costs posed by mental disabilities, not only to the individuals who suffer from them, but also to their families, to employers, and to society as a whole. The authors also discuss uncertainties that inhere in available data concerning both the prevalence of these conditions and the related costs of treatment, as well as the complexity of drawing correlations among variables with respect to these costs and the difficulty of identifying a meaningful measure of the economic consequences that attend mental disabilities. Copyright © 2017 John Wiley & Sons, Ltd.