Recession 'impacts people with mental illness most' ...

"Mentally ill people hit hard by recession," BBC News reports. The website reports on an important study covering an issue that is often overlooked: the discrimination of some people with chronic mental health conditions, both in the jobs market and in society.

The study looked at data on the rates of employment and mental health problems from 27 EU countries. The researchers focused on data from 2006, prior to the 2008 economic crisis, and 2010, after the onset of the recession. They found a consistent pattern: in both years, people with mental health problems were more likely to be unemployed.

However, by 2010 the gap in unemployment rates between people with and without mental health problems had widened. This suggests that people with mental health problems may have been hit harder by the economic recession since 2008.

There are some limitations to these findings, however, including that the data was collected through brief, self-reported questionnaires, and that diagnoses of mental health problems were not validated.

Overall, this is a valuable study that suggests that people with mental health problems may be more vulnerable to the risk of unemployment during times of economic recession. The reasons for this need to be explored further.

Where did the story come from?

The study was carried out by researchers from King's College London and the London School of Economics and Political Science in the UK, and Johns Hopkins Bloomberg School of Public Health in the US.

The study received no sources of external funding and was published in the peer-reviewed open access medical journal PLOS One.

The BBC's and The Times' reporting of the study was accurate and contained useful advice from a number of independent experts.

What kind of research was this?

The researchers discussed how several studies have observed disparities in unemployment rates between people with and without mental health conditions.

People with mental health conditions tend to have higher rates of unemployment. This can often lead to a worsening of symptoms, as these people become more isolated and no longer have the reassurance of a regular income. This poses the risk of a vicious circle developing – people with poor mental health have problems finding a job, which makes their mental health worse, and so on.

The issue is of particular concern because of the current period of economic recession resulting from the banking crash of 2008. Times of economic hardship may be particularly difficult for people with mental health problems, putting them at higher risk of losing their job and making it harder for them to find a new job in a competitive labour market.

The researchers intended to investigate the impact of the economic recession on people with mental health problems using survey data collected from 27 EU countries in 2006 and 2010.

They wanted to investigate the theory that the banking crash and resulting austerity measures have had a greater impact on the employment of people with a mental health problems.

What did the research involve?

This research used data from two surveys: the Eurobarometer Mental Wellbeing 2006 survey and the Eurobarometer Mental Health 2010 survey.

On both occasions, a random selection of the population were contacted and asked to participate. Information was collected through face-to-face interviews with almost 30,000 citizens from 27 EU countries.

For the purposes of the current study, the researchers restricted their analyses to only those people of working age (18-64 years), giving a sample of 20,368 in 2006 and 20,124 in 2010.

Mental health problems were assessed using the Mental Health Inventory-5. This is a brief questionnaire designed to screen for symptoms such as depression and anxiety. Example questions include: "During the past month, how much of the time were you a happy person?" with answers ranging from "none of the time" to "all of the time".

But, as the researchers point out, a validated score indicating mental health illness has not yet been agreed by experts.

For the purposes of the current study, people scoring one standard deviation above the mean (average) score were defined as having mental health problems.

The concept of stigma towards people with mental health problems was assessed (in 2006 only) by asking people to rate on a scale how much they agreed or disagreed with the following statements:

people with psychological or emotional health problems constitute a danger to others
people with psychological or emotional health problems are unpredictable
people with psychological or emotional health problems have themselves to blame
people with psychological or emotional health problems never recover

Sociodemographic information was collected on educational level, urbanicity (whether or not a person lived in an urban environment) and current employment status, which included various options:

home-maker – responsible for ordinary shopping and looking after the home, without any current occupation, or not working
student
unemployed or temporarily not working
retired or unable to work through illness in paid employment

National unemployment figures for 2006 and 2010 were obtained from the Eurostat yearbook, an annual statistical report compiled by the European Union on EU nation states.

Logistic regression models were used to examine predictors of unemployment for individuals with and without mental health problems in 2006 and 2010. Logistic regression is a statistical technique used to account for the potential influence of multiple probabilities.

What were the basic results?

The researchers found that in both 2006 and 2010 surveys, compared with the general population people with mental health problems were:

more likely to be female
significantly older
more likely to have finished education prior to the age of 20 or had no further education
more likely to be unemployed/retired/unable to work through illness
less likely to be in paid employment, a student or a home-maker

Looking at overall rates of unemployment for all people, unemployment was higher in 2010 than 2006. However, the gap in unemployment rates between people with and without mental health problems had widened in 2010 compared with unemployment rates in 2006.

When conducting further analyses, they found that the more mental health problems a person had, the more likely they were to be unemployed relative to the rest of the general population.

They also observed that among people with mental health illness, males were more likely than females to be unemployed in 2010 (in 2006 the difference wasn't significant). In 2010, 22% of men with mental health problems were unemployed, compared with 14% in 2006. For women, these respective proportions were 17% and 12%.

In general, among the whole population younger individuals (aged 18-29) were more likely to be unemployed than older individuals (aged 50-64). However, this effect wasn't as consistent among people with mental health problems. Unemployed people with mental health problems were significantly older than unemployed people without mental health problems.

Further observations related to stigma:

In 2010 (but not in 2006) people with mental health problems were more likely to be unemployed if they lived in a country where a higher proportion of people agreed with the statement "people with mental health problems are a danger to others".
People with mental health problems were more likely to be unemployed if they lived in a country where a higher proportion of people agreed with the statement "people with mental health illness will never recover".
Somewhat inconsistently with these two patterns, however, was the finding that in both 2006 and 2010 people with mental health problems were more likely to be unemployed if they were living in countries where fewer people believed "people with mental health illness have themselves to blame".

How did the researchers interpret the results?

The researchers conclude that their findings "suggest that times of economic hardship may intensify social exclusion of people with mental health problems, especially males and individuals with lower education".

They suggest that, "interventions to combat economic exclusion and to promote social participation of individuals with mental health problems are even more important during times of economic crisis, and these efforts should target support to the most vulnerable groups".

Conclusion

This is a valuable study that provides information from 27 EU countries on the rates of employment and mental health problems in 2006, prior to the 2008 economic crisis, and in 2010, after the onset of the recession.

The researchers found a consistent pattern – in both years, people with mental health problems were more likely to be unemployed.

However, by 2010 the gap in unemployment rates between people with and without mental health problems had widened compared with 2006. This suggests that people with mental health problems may have been hit harder by the economic recession since 2008.

Researchers also found other worrying trends, including that among people with mental health problems, males were more likely to be unemployed than females.

There also appeared to be issues relating to stigma. After the recession, people with mental health problems were more likely to be unemployed if they lived in a country where more people believed that people with mental health problems are "a danger to others" or "will never recover".

However, perhaps inconsistently with this pattern, people with mental health problems were also more likely to be unemployed if they lived in a country where fewer people believed they "had themselves to blame".

There are some limitations to these findings, however.

The data was collected through brief, self-reported questionnaires.
It is not known how many people of working age were asked to participate and how many refused or were unable to because of severe mental health problems.
The presence of mental health problems was not obtained through medical records or a diagnosis verified by a doctor, but by scoring above average on the questionnaire used, which – as the researchers acknowledge – is not a validated method for diagnosing mental health problems.
There was also no information about the mental health condition the person had, its severity, or whether the person was receiving treatment.
The study examined only two points in time, so it is difficult to fully examine the effects of the economic recession or say for definite that all the trends observed were because of this.

Finally, although several associations with stigma were observed, perception and attitudes towards people with mental health problems were only assessed in 2006, so it is not possible to assess whether there were any changes in attitude.

Overall, however, these are valuable findings that suggest that people with mental health problems may be more vulnerable to the risk of unemployment during times of economic recession.