International Journal of Epidemiology, Vol 28, 95-100, Copyright © 1999 by International Epidemiological Association
SM Montgomery, DG Cook, MJ Bartley and ME Wadsworth
BACKGROUND: There is evidence to support a link between unemployment and
lower levels of psychological well-being, but debate continues as to
whether unemployment results in psychological morbidity, or whether the
association is due to those who are more vulnerable to mental illness
becoming unemployed. Here we assess the effect of recent and accumulated
unemployment in young men on the risk of developing depression and anxiety
leading to medical consultation. Adjustment was made for a measure of
pre-existing tendency to depression, behavioural maladjustment, social
class, qualifications and region of residence. METHODS: Some 3241 men from
the National Child Development Study (the 1958 British birth cohort) with
data from birth to age 33 years, collected at birth and ages 7, 11, 16, 23
and 33 years were used in these analyses. The outcome measure was onset age
of anxiety or depression between ages 24 and 33 years, that resulted in
consultation with a GP or a specialist. This was used in Cox proportional
hazards models where two measures of unemployment were modelled as time
varying covariates. Pre-existing tendency to depression was measured by the
Malaise Inventory prior to the experience of unemployment at age 23 years.
Two measures of unemployment were investigated: any unemployment in the
year prior to onset (recent unemployment) and all accumulated unemployment
prior to onset (divided into four categories: 0, 1-12, 13- 36 and 37+
months of unemployment). RESULTS: After adjustment for potential
confounding factors including pre-existing tendency to depression, the
relative risk (RR) for developing symptoms resulting in consultation was
2.10 (95% CI: 1.21-3.63), when those who were unemployed in the year prior
to onset were compared with those who were not. Accumulated unemployment
was not statistically significantly related to onset of symptoms in all men
after adjustment for the potential confounding factors: an RR of 1.63 (95%
CI: 0.95-2.79) for men with 37+ months of accumulated unemployment when
compared with none. However, exclusion of men with a pre-existing tendency
to depression indicated by the Malaise Inventory score, increased the RR to
2.30 (95% CI: 1.44-3.65) for recent unemployment and 2.04 (95% CI:
1.17-3.54) for 37+ months of accumulated unemployment when compared with
none. CONCLUSIONS: Unemployment is a risk factor for psychological symptoms
of depression requiring medical attention, even in those men without
previous psychological vulnerability.
ARTICLES
Unemployment pre-dates symptoms of depression and anxiety resulting in medical consultation in young men
University Department of Medicine, Royal Free Hospital School of Medicine, University of London, UK.
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