Poverty, unemployment, and common mental disorders: population based cohort study

BMJ 1998;317:115-119 ( 11 July )

Papers

Poverty, unemployment, and common mental disorders: population based cohort study

Scott Weich, senior lecturer, ^a Glyn Lewis, professor. ^b

^a University Department of Psychiatry, Royal Free Hospital School of Medicine, London NW3 2PG, ^b Division of Psychological Medicine, University of Wales College of Medicine, Cardiff CF4 4XN

Correspondence to: Dr Weich scott{at}rfhsm.ac.uk

Objective: To determine whether poverty and unemployment increase the likelihood of or delay recovery from common mentaldisorders, and whether these associations could be explained bysubjective financialstrain.
Design: Prospective cohortstudy.
Setting: England, Wales, andScotland.
Subjects: 7726 adults aged 16-75 living in private households.
Main outcome measures: Common mental disorders were assessed using the general health questionnaire, a self assessedmeasure of psychiatricmorbidity.
Results: Poverty and unemployment (odds ratio 1.86, 95% confidence interval 1.18 to 2.94) were associated with themaintenance but not onset of episodes of common mental disorders.Associations between poverty and employment and maintenance ofcommon mental disorders, however, were much smaller than thoseof cross sectional studies. Financial strain at baseline was independentlyassociated with both onset (1.57, 1.19 to 2.07) and maintenance(1.86, 1.36 to 2.53) even after adjusting for objective indicesof standard of living.
Conclusions: Poverty and unemployment increased the duration of episodes of common mental disorders but not the likelihoodof their onset. Financial strain was a better predictor of futurepsychiatric morbidity than either of these more objective riskfactors though the nature of this risk factor and its relationwith poverty and unemployment remainunclear.

Key messages

The prevalence of the most common mental disorders, anxiety and depression, has been shown to be consistently associated with unemployment and measures of poverty, independent of occupational social class
Unemployment and poverty were associated with the maintenance of episodes of most common mental disorders but not their onset
Financial strain was a powerful independent predictor of both the onset and maintenance of episodes of common mental disorders, even after adjusting for more objective measures of standard of living
Over 12 months poverty and financial strain, but not unemployment, were associated with significant increases in psychiatric morbidity; the effect of poverty increased with the level of baseline morbidity
Further research is needed to better understand the nature of financial strain and its relation with unemployment and objective measures of standard of living

© BMJ 1998

CiteULike

Complore

Connotea

Del.icio.us Add to Digg

Digg

Technorati What's this?

Relevant Article

Financial strain has a major impact on mental health
BMJ 1998 317: 0. [Full Text]

This article has been cited by other articles:

Laaksonen, E, Martikainen, P, Lallukka, T, Lahelma, E, Ferrie, J, Rahkonen, O, Marmot, M, Head, J (2009). Economic difficulties and common mental disorders among Finnish and British white-collar employees: the contribution of social and behavioural factors. J. Epidemiol. Community Health 63: 439-446 [Abstract] [Full text]
King, M., Walker, C., Levy, G., Bottomley, C., Royston, P., Weich, S., Bellon-Saameno, J. A., Moreno, B., Svab, I., Rotar, D., Rifel, J., Maaroos, H.-I., Aluoja, A., Kalda, R., Neeleman, J., Geerlings, M. I., Xavier, M., Carraca, I., Goncalves-Pereira, M., Vicente, B., Saldivia, S., Melipillan, R., Torres-Gonzalez, F., Nazareth, I. (2008). Development and Validation of an International Risk Prediction Algorithm for Episodes of Major Depression in General Practice Attendees: The PredictD Study. Arch Gen Psychiatry 65: 1368-1376 [Abstract] [Full text]
Kendrick, T, Dunn, N, Robinson, S, Oestmann, A, Godfrey, K, Cooper, C, Inskip, H, the Southampton Women's Survey Study Group, (2008). A longitudinal study of blood folate levels and depressive symptoms among young women in the Southampton Women's Survey. J. Epidemiol. Community Health 62: 966-972 [Abstract] [Full text]
O'Reilly, D., Rosato, M., Connolly, S., Cardwell, C. (2008). Area factors and suicide: 5-year follow-up of the Northern Ireland population. Br. J. Psychiatry 192: 106-111 [Abstract] [Full text]
WEICH, S., NAZARETH, I., MORGAN, L., KING, M. (2007). Treatment of depression in primary care: Socio-economic status, clinical need and receipt of treatment. Br. J. Psychiatry 191: 164-169 [Abstract] [Full text]
Laaksonen, E., Martikainen, P., Lahelma, E., Lallukka, T., Rahkonen, O., Head, J., Marmot, M. (2007). Socioeconomic circumstances and common mental disorders among Finnish and British public sector employees: evidence from the Helsinki Health Study and the Whitehall II Study. Int J Epidemiol 36: 776-786 [Abstract] [Full text]
LORANT, V., CROUX, C., WEICH, S., DELIEGE, D., MACKENBACH, J., ANSSEAU, M. (2007). Depression and socio-economic risk factors: 7-year longitudinal population study. Br. J. Psychiatry 190: 293-298 [Abstract] [Full text]
Thomas, C., Benzeval, M., Stansfeld, S. (2007). Psychological distress after employment transitions: the role of subjective financial position as a mediator. J. Epidemiol. Community Health 61: 48-52 [Abstract] [Full text]
Mukherjee, S., Sullivan, G., Perry, D., Verdugo, B., Means-Christensen, A., Schraufnagel, T., Sherbourne, C. D., Stein, M. B., Craske, M. G., Roy-Byrne, P. P. (2006). Adherence to Treatment Among Economically Disadvantaged Patients With Panic Disorder. Psychiatr. Serv. 57: 1745-1750 [Abstract] [Full text]
Roy-Byrne, P., Sherbourne, C., Miranda, J., Stein, M., Craske, M., Golinelli, D., Sullivan, G. (2006). Poverty and Response to Treatment Among Panic Disorder Patients in Primary Care. Am. J. Psychiatry 163: 1419-1425 [Abstract] [Full text]
Skapinakis, P., Weich, S., Lewis, G., Singleton, N., Araya, R. (2006). Socio-economic position and common mental disorders: Longitudinal study in the general population in the UK. Br. J. Psychiatry 189: 109-117 [Abstract] [Full text]
WEICH, S., TWIGG, L., LEWIS, G. (2006). Rural/non-rural differences in rates of common mental disorders in Britain: Prospective multilevel cohort study. Br. J. Psychiatry 188: 51-57 [Abstract] [Full text]
Feldman, J. M., Siddique, M. I., Morales, E., Kaminski, B., Lu, S.-E., Lehrer, P. M. (2005). Psychiatric Disorders and Asthma Outcomes Among High-Risk Inner-City Patients. Psychosom. Med. 67: 989-996 [Abstract] [Full text]
WILES, N. J., PETERS, T. J., LEON, D. A., LEWIS, G. (2005). Birth weight and psychological distress at age 45-51 years: Results from the Aberdeen Children of the 1950s cohort study. Br. J. Psychiatry 187: 21-28 [Abstract] [Full text]
WEICH, S., TWIGG, L., LEWIS, G., JONES, K. (2005). Geographical variation in rates of common mental disorders in Britain: prospective cohort study. Br. J. Psychiatry 187: 29-34 [Abstract] [Full text]
Weich, S. (2005). Absence of spatial variation in rates of the common mental disorders. J. Epidemiol. Community Health 59: 254-257 [Full text]
Thomas, C., Benzeval, M., Stansfeld, S. A (2005). Employment transitions and mental health: an analysis from the British household panel survey. J. Epidemiol. Community Health 59: 243-249 [Abstract] [Full text]
Wiggins, R D, Schofield, P, Sacker, A, Head, J, Bartley, M (2004). Social position and minor psychiatric morbidity over time in the British Household Panel Survey 1991-1998. J. Epidemiol. Community Health 58: 779-787 [Abstract] [Full text]
Honey, A. (2004). Benefits and Drawbacks of Employment: Perspectives of People with Mental Illness. Qual Health Res 14: 381-395 [Abstract]
Virtanen, P, Liukkonen, V, Vahtera, J, Kivimaki, M, Koskenvuo, M (2003). Health inequalities in the workforce: the labour market core-periphery structure. Int J Epidemiol 32: 1015-1021 [Abstract] [Full text]
Weich, S, Twigg, L, Holt, G, Lewis, G, Jones, K (2003). Contextual risk factors for the common mental disorders in Britain: a multilevel investigation of the effects of place. J. Epidemiol. Community Health 57: 616-621 [Abstract] [Full text]
Araya, R, Lewis, G, Rojas, G, Fritsch, R (2003). Education and income: which is more important for mental health?. J. Epidemiol. Community Health 57: 501-505 [Abstract] [Full text]
Mauksch, L. B., Katon, W. J., Russo, J., Tucker, S. M., Walker, E., Cameron, J. (2003). The Content of a Low-income, Uninsured Primary Care Population: Including the Patient Agenda. J Am Board Fam Med 16: 278-289 [Abstract] [Full text]
Maiden, N. L., Hurst, N. P., Lochhead, A., Carson, A. J., Sharpe, M. (2003). Quantifying the burden of emotional ill-health amongst patients referred to a specialist rheumatology service. Rheumatology (Oxford) 42: 750-757 [Abstract] [Full text]
Stansfeld, S A, Head, J, Fuhrer, R, Wardle, J, Cattell, V (2003). Social inequalities in depressive symptoms and physical functioning in the Whitehall II study: exploring a common cause explanation. J. Epidemiol. Community Health 57: 361-367 [Abstract] [Full text]
Weich, S., Holt, G., Twigg, L., Jones, K., Lewis, G. (2003). Geographic Variation in the Prevalence of Common Mental Disorders in Britain: A Multilevel Investigation. Am J Epidemiol 157: 730-737 [Abstract] [Full text]
Lorant, V., Deliege, D., Eaton, W., Robert, A., Philippot, P., Ansseau, M. (2003). Socioeconomic Inequalities in Depression: A Meta-Analysis. Am J Epidemiol 157: 98-112 [Abstract] [Full text]
Maiden, N. L., Hurst, N. P., Lochhead, A., Carson, A. J., Sharpe, M. (2003). Medically unexplained symptoms in patients referred to a specialist rheumatology service: prevalence and associations. Rheumatology (Oxford) 42: 108-112 [Abstract] [Full text]
Weich, S, Lewis, G, Jenkins, S P (2002). Income inequality and self rated health in Britain. J. Epidemiol. Community Health 56: 436-441 [Abstract] [Full text]
Ferrie, J E, Shipley, M J, Stansfeld, S A, Marmot, M G (2002). Effects of chronic job insecurity and change in job security on self reported health, minor psychiatric morbidity, physiological measures, and health related behaviours in British civil servants: the Whitehall II study. J. Epidemiol. Community Health 56: 450-454 [Abstract] [Full text]
Blank, N., Burstrom, B. (2002). Limiting long-term illness and the experience of financial strain in Sweden. Scand J Public Health 30: 41-46 [Abstract]
RITSHER, J. E. B., WARNER, V., JOHNSON, J. G., DOHRENWEND, B. P. (2001). Inter-generational longitudinal study of social class and depression: a test of social causation and social selection models. Br. J. Psychiatry 178 : s84-s90 [Abstract] [Full text]
Lewis, G., Araya, R. (2001). Classification, disability and the public health agenda: Depression and public health. Br Med Bull 57: 3-15 [Abstract] [Full text]
Patel, V. (2001). Cultural factors and international epidemiology: Depression and public health. Br Med Bull 57: 33-45 [Abstract] [Full text]
WEICH, S., LEWIS, G., JENKINS, S. P. (2001). Income inequality and the prevalence of common mental disorders in Britain. Br. J. Psychiatry 178: 222-227 [Abstract] [Full text]
Ismail, K., Blatchley, N., Hotopf, M., Hull, L., Palmer, I., Unwin, C., David, A., Wessely, S. (2000). Occupational risk factors for ill health in Gulf veterans of the United Kingdom. J. Epidemiol. Community Health 54: 834-838 [Abstract] [Full text]
KORTEN, A., HENDERSON, S. (2000). The Australian National Survey of Mental Health and Well-Being: Common psychological symptoms and disablement. Br. J. Psychiatry 177: 325-330 [Abstract] [Full text]
Saurel-Cubizolles, M.-J., Romito, P., Ancel, P.-Y., Lelong, N. (2000). Unemployment and psychological distress one year after childbirth in France. J. Epidemiol. Community Health 54: 185-191 [Abstract] [Full text]
Hintikka, J., Kontula, O., Niskanen, L., Koskela, K., Viinamaki, H. (2000). Increase in the prevalence of common mental disorders during an upswing in the national economy. Scand J Public Health 28: 79-80
Leino-Arjas, P., Liira, J., Mutanen, P., Malmivaara, A., Matikainen, E. (1999). Predictors and consequences of unemployment among construction workers: prospective cohort study. BMJ 319: 600-605 [Abstract] [Full text]