Pathways between health, education and income in adolescence and adulthood

The working life expectancy of American adults experiencing depression

OBJECTIVES

To estimate the working life expectancies (WLE) of men and women with depression, examining depression by symptom trajectories from the late 20s to early 50s, and to estimate WLE by race/ethnicity and educational attainment.

METHODS

Data from 9206 participants collected from 1979 to 2018 in the US National Longitudinal Survey of Youth 1979 cohort were used. Depression was measured using the Center for Epidemiologic Studies Depression Scale Short Form at four time points (age 28-35, age 30-37, age 40, and age 50). Labor force status was measured monthly starting at age 30 until age 58-62. Depressive symptom trajectories were estimated using growth mixture modeling and multistate modeling estimated WLE from age 30-60 for each gender and depressive symptom trajectory.

RESULTS

Five latent symptom trajectories were established: a persistent low symptom trajectory (n = 6838), an episodic trajectory with high symptoms occurring before age 40 (n = 995), an episodic trajectory with high symptoms occurring around age 40 (n = 526), a trajectory with high symptoms occurring around age 50 (n = 570), and a persistent high symptom trajectory (n = 277). The WLE for men at age 30 was 30.3 years for the persistent low symptom trajectory, 22.8 years for the episodic before 40 trajectory, 19.6 years for the episodic around age 40 trajectory, 18.6 years for the episodic around age 50 trajectory, and 13.2 years for the persistent high symptom trajectory. Results were similar for women. WLE disparities between depression trajectories grew when stratified by race/ethnicity and education level.

CONCLUSIONS

Roughly a quarter of individuals experienced episodic depressive symptoms. However, despite periods of low depressive symptoms, individuals were expected to be employed ~5-17 years less at age 30 compared to those with low symptoms. Accessible employment and mental health disability support policies and programs across the working life course may be effective in maintaining work attachment and improving WLE among those who experience depression.

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.

A Chronic Disease in Adolescence and Selection to an Educational Path-A Longitudinal Study

Chronic disease may affect adolescents' educational success. We study whether adolescents with a somatic chronic condition have lower school performance, lower odds for academic education, and a delayed start of upper-secondary studies. Seventh graders and ninth graders in the Helsinki Metropolitan Region, Finland, were invited to participate in a school survey in 2011 and 2014, respectively. The respondents (2011, N = 8960; 2014, N = 7394) were followed using a national application registry until 2017. The chronic conditions were asthma, diabetes, and epilepsy. Outcomes were grade point average (GPA), study place in an academic school, and delayed start of secondary education. Adolescents with a chronic disease needing medication had lower GPAs in both grades. Chronic disease with medication in the seventh grade predicted higher odds for the non-academic track (OR = 1.3) and the delayed start (OR = 1.4). In the ninth grade, chronic disease predicted non-academic studies univariately (OR = 1.2) and was not associated with the delayed start. The somatic chronic condition with medication, particularly epilepsy, slightly lowers students' school performance, which is a mediator between the chronic condition and selection into educational paths. Compared to gender and parents' education, and particularly to GPA, the role of chronic conditions on educational outcomes is small.

Inequities in vulnerable children's access to health services in Australia

INTRODUCTION

Children born into families at risk of becoming or remaining poor are at significant risk of experiencing childhood poverty, which can impair their start to life, and perpetuate intergenerational cycles of poverty. This study sought to quantify health service utilisation, costs and funding distribution amongst children born into vulnerable compared to non-vulnerable families.

METHODS

This study used a large linked administrative dataset for all women giving birth in Queensland, Australia between July 2012 and July 2018. Health service use included inpatient, emergency department (ED), general practice, specialist, pathology and diagnostic imaging services. Costs included those paid by public hospital funders, private health insurers, Medicare and out-of-pocket costs.

RESULTS

Vulnerable children comprised 34.1% of the study cohort. Compared with non-vulnerable children, they used significantly higher average numbers of ED services during the first 5 years of life (2.52±3.63 vs 1.97±2.77), and significantly lower average numbers of specialist, pathology and diagnostic imaging services. Vulnerable children incurred significantly greater costs to public hospital funders compared with non-vulnerable children over the first 5 years of life ($16 053 vs $10 247), and significantly lower private health insurer, Medicare and out-of-pocket costs.

CONCLUSION

There are clear inequities in vulnerable children's health service utilisation in Australia. Greater examination of the uptake and cost-effectiveness of maternal and child services is needed, as these services support children's development in the critical first 1000 days of life.

Gender differences in the mental health impact of the COVID-19 lockdown: Longitudinal evidence from the Netherlands

Recent contributions highlighted gender differences in the mental health consequences of COVID-19 lockdowns. However, their cross-sectional designs cannot differentiate between pre-existing gender differences and differences induced by lockdowns. Estimating fixed-effects models using longitudinal data from the Lifelines biobank and cohort study with repeated mental health measurements throughout the lockdown, we overcome this caveat. Significant gender differences in mental health during the lockdown were found, where women experienced more depression symptoms and disorders and men experienced more anxiety symptoms and disorders stemming from the lockdown. Policymakers need to keep in mind that the COVID-19 lockdowns have different effects on mental health for men and women.

Major Depressive Episodes and Employment Earnings Trajectories over the Following Decade among Working-aged Canadian Men and Women

OBJECTIVE

Quantify the association between experiencing a major depressive episode (MDE) and employment earnings over the following decade among working-aged Canadian men and women.

METHODS

Ten national Canadian Community Health Survey (CCHS 2003-2014) cycles were linked to administrative tax records (1997-2016) for individuals 18-54 years old with information on past year MDE defined by the Composite International Diagnostic Interview Short Form (n=85,155) measured at baseline. Subsequent earnings were measured annually two to ten years post-MDE. MDE cases were matched with adult controls without MDE using 1:1 greedy nearest-neighbour without replacement propensity score matching for women and men.

RESULTS

Using random-effects longitudinal modelling, among women (n=6,974) in the matched cohort (average initial earnings ~$52,119/annum, 2016 Canadian real dollars), experiencing an MDE was associated with average earnings of $4,473 less in the year the MDE was reported (95%CI=-$3,215,-$5,731) and an additional $363 less/year over the following decade (95%CI=-$132,-$594). Among men (n=3,620, average initial earnings ~$76,110/annum), an MDE was associated with an initial reduction in earnings of $5,023 (95%CI=-$2,453,-$7,593) followed by an earnings decline starting with $730/year, increasing to ~$1,810/year at ten years post-MDE.

LIMITATIONS

Residual confounding by measures excluded from the propensity score. Only one MDE measurement limited exploring earnings trajectories of those with multiple episodes.

CONCLUSIONS

Consistently lower earnings were seen for ten years after experiencing one MDE. The magnitude of earnings difference immediately after the MDE was similar for men and women. Findings reveal the critical period surrounding an MDE where effective clinical treatment and labor policy may help buffer longstanding earnings loss.

Joint production of research priorities to improve the lives of those with childhood onset conditions that impair learning: the James Lind Alliance Priority Setting Partnership for 'learning difficulties'

OBJECTIVES

To engage children and young people with conditions that impair learning, their parents/carers and the health, education, social work and third sector professionals to identify and prioritise research questions for learning difficulties.

DESIGN

Prospective surveys and consensus meeting guided by methods advocated by the James Lind Alliance.

SETTING

Scotland.

METHODS

The Priority Setting Partnership came together through discussion and collaboration between the University of Edinburgh, Scottish charity The Salvesen Mindroom Centre and partners in the National Health Service, education services and the third sector. A steering group was established. Charity and professional organisations were recruited. Suggested questions were gathered in an open survey and from research recommendations by the National Institute for Health and Care Excellence and Scottish Intercollegiate Guidelines Network Guidance. Suggested questions and recommendations were summarised into 40 indicative research questions. These indicative questions were verified as uncertainties from research evidence. Respondents each nominated up to 10 questions as research priorities in an interim survey. The 25 highest-ranked questions from the interim survey were prioritised at the final priority setting workshop.

PARTICIPANTS

367 people submitted suggestions (29 individuals affected by learning difficulties, 147 parents/carers and 191 professionals). 361 people participated in the interim prioritisation (41 individuals, 125 parents/carers and 195 professionals). 25 took part in the final workshop (5 young people, 6 parents and 14 professionals).

RESULTS

Top three research priorities related to (1) upskilling education professionals, (2) best education and community environment and (3) multidisciplinary practice and working with parents. Top 10 included best early interventions, upskilling health, social and third sector professionals, support for families, identifying early signs and symptoms, effective assessments and strategies against stigma and bullying and to live independent lives.

CONCLUSIONS

Results will now be a resource for researchers and funders to understand and resolve learning difficulties and improve the lives of those affected with childhood onset conditions that result in learning difficulties.