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Does the effect of disability acquisition on mental health differ by employment characteristics? A longitudinal fixed-effects analysis.

ABSTRACT: PURPOSE:Longitudinal studies have suggested a causal relationship between disability acquisition and mental health, but there is substantial heterogeneity in the magnitude of the effect. Previous studies have provided evidence that socioeconomic characteristics can buffer the effect but have not examined the role of employment characteristics. METHODS:We used data from 17 annual waves of the Household, Income and Labour Dynamics in Australia Survey to compare the mental health of working age individuals before and after disability acquisition, using the Mental Health Inventory, a subscale of the SF-36 health questionnaire. Linear fixed-effects regression models were used to estimate the effect of disability acquisition on mental health. We tested for effect modification by two characteristics of people's employment prior to disability acquisition: occupational skill level and contract type. Multiple imputation using chained equations was used to handle missing data. RESULTS:Disability acquisition was associated with a substantial decline in mental health score (estimated mean difference: - 4.3, 95% CI - 5.0, - 3.5). There was evidence of effect modification by occupational skill level, with the largest effects seen for those in low-skilled jobs (- 6.1, 95% CI - 7.6, - 4.5), but not for contract type. CONCLUSIONS:The findings highlight the need for social and health policies that focus on increasing employment rates, improving the sustainability of employment, and providing employment services and education and training opportunities for people who acquire a disability, particularly for people in low-skilled occupations, to reduce the mental health inequalities experienced by people with disabilities.

SUBMITTER: Aitken Z

PROVIDER: S-EPMC7395044 | biostudies-literature | 2020 Aug

REPOSITORIES: biostudies-literature

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Does the effect of disability acquisition on mental health differ by employment characteristics? A longitudinal fixed-effects analysis.

Aitken Zoe Z Simpson Julie Anne JA Bentley Rebecca R Milner Allison A LaMontagne Anthony Daniel AD Kavanagh Anne Marie AM

Social psychiatry and psychiatric epidemiology 20191024 8

<h4>Purpose</h4>Longitudinal studies have suggested a causal relationship between disability acquisition and mental health, but there is substantial heterogeneity in the magnitude of the effect. Previous studies have provided evidence that socioeconomic characteristics can buffer the effect but have not examined the role of employment characteristics.<h4>Methods</h4>We used data from 17 annual waves of the Household, Income and Labour Dynamics in Australia Survey to compare the mental health of ...[more]

PMID: 31650207

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Project description:ObjectivesThere is evidence of a causal relationship between disability acquisition and poor mental health, but the substantial heterogeneity in the magnitude of the effect is poorly understood and may be aetiologically informative. This study aimed to identify demographic and socioeconomic factors that modify the effect of disability acquisition on mental health.Design and settingThe Household, Income and Labour Dynamics in Australia Survey is a nationally representative longitudinal survey of Australian households that has been conducted annually since 2001. Four waves of data were included in this analysis, from 2011 to 2014.ParticipantsIndividuals who acquired a disability (n=387) were compared with those who remained disability-free in all four waves (n=7936).Primary outcome measureMental health was measured using the mental health subscale of the Short Form 36 (SF-36) general health questionnaire, which measures symptoms of depression, anxiety and psychological well-being.MethodsLinear regression models were fitted to estimate the effect of disability acquisition on mental health, testing for effect modification by key demographic and socioeconomic characteristics. To maximise causal inference, we used a propensity score approach with inverse probability of treatment weighting to control for confounding and multiple imputation using chained equations to assess the impact of missing data.ResultsOn average, disability acquisition was associated with a 5-point decline in mental health score (estimated mean difference: -5.1, 95%?CI -7.2 to -3.0). There was strong evidence that income and relationship status modified the effect, with more detrimental effects in the lowest (-12.5, 95%?CI -18.5 to -6.5) compared with highest income quintile (-1.1, 95%?CI -4.9 to 2.7) and for people not in a relationship (-8.8, 95%?CI -12.9 to -4.8) compared with those who were (-3.7, 95%?CI -6.1 to -1.4).ConclusionsOur results suggest that the detrimental effect of disability acquisition on mental health is substantially greater for socioeconomic disadvantaged individuals.

Project description:ObjectivesThere is evidence that disability acquisition causes a decline in mental health, but few studies have examined the causal mechanisms through which the effect operates. This study used a novel approach to mediation analysis to quantify interventional indirect effects (IIEs) through employment and income.Design and settingWe used four waves of longitudinal data (2011-2014) from the Household, Income and Labour Dynamics in Australia Survey, a nationally representative survey of Australian households.ParticipantsWorking aged individuals who acquired a disability (n=233) were compared with those who remained disability-free in all four waves (n=5419).Primary outcome measureSelf-reported mental health was measured using the Mental Health Inventory subscale of the Short Form 36 general health questionnaire, which measures symptoms of depression, anxiety and psychological well-being.Statistical analysisWe conducted a causal mediation analysis quantifying IIEs of disability acquisition on mental health operating through two distinct mediators: employment status and income. We used multiple imputation with 50 imputed datasets to account for missing data.ResultsThe total causal effect of disability acquisition on mental health was estimated to be a 4.8-point decline in mental health score (estimated mean difference: -4.8, 95% CI -7.0 to -2.7). The IIE through employment was estimated to be a 0.5-point difference (-0.5, 95% CI -1.0 to 0.0), accounting for 10.6% of the total effect, whereas there was no evidence that income explained any of the effects.ConclusionsThis study estimated that disability-related mental health inequalities could be reduced by 10.6% if employment rates were the same for people with disability as those without disability. The results suggest that employment is implicated in the relationship between disability acquisition and mental health and that more research is needed to understand the influence of other aspects of employment and other socioeconomic characteristics.

Project description:BackgroundEmpirical evidence investigating heterogeneous impact of retirement on mental health depending on social backgrounds is lacking, especially among older adults.MethodsWe examined the impact of changes in working status on changes in mental health using Japanese community-dwelling adults aged ?65 years participating in the Japan Gerontological Evaluation Study between 2010 and 2013 (N = 62,438). Between-waves changes in working status ("Kept working", "Retired", "Started work", or "Continuously retired") were used to predict changes in depressive symptoms measured by the Geriatric Depression Scale. First-difference regression models were stratified by gender, controlling for changes in time-varying confounding actors including equivalised household income, marital status, instrumental activities of daily living, incidence of serious illnesses and family caregiving. We then examined the interactions between changes in working status and occupational class, changes in marital status, and post-retirement social participation.ResultsParticipants who transitioned to retirement reported significantly increased depressive symptoms (? = 0.33, 95% CI: 0.21-0.45 for men, and ? = 0.29, 95% CI: 0.13-0.45 for women) compared to those who kept working. Men who were continuously retired reported increased depressive symptoms (? = 0.13, 95% CI: 0.05-0.20), whereas males who started work reported decreased depressive symptoms (? = -0.20, 95% CI: -0.38--0.02). Men from lower occupational class (compared to men from higher class) reported more increase in depressive symptoms when continuously retired (? = -0.16, 95% CI: -0.25--0.08). Those reporting recreational social participation after retirement appeared to be less influenced by transition to retirement.ConclusionsRetirement may increase depressive symptoms among Japanese older adults, particularly men from lower occupational class backgrounds. Encouraging recreational social participation may mitigate the adverse effects of retirement on mental health of Japanese older men.

Project description:Purpose To evaluate the influence of an interdisciplinary re-employment programme on labour force participation and perceived health among unemployed persons with common mental health problems. In addition, the influence of entering paid employment on self-rated physical health and mental health was investigated. Methods In this quasi-experimental study with 2 years follow up, 869 persons were enrolled after referral to an interdisciplinary re-employment programme (n?=?380) or regular re-employment programme (n?=?489). The propensity score technique was used to account for observed differences between the intervention and control group. The intervention programme was provided by an interdisciplinary team, consisting of mental health care professionals as well as employment specialists. Mental health problems were addressed through cognitive counselling and individual tailored job-search support was provided by an employment professional. Primary outcome measures were paid employment and voluntary work. Secondary outcome measures were self-rated mental and physical health, measured by the Short Form 12 Health Survey, and anxiety and depressive symptoms, measured by the Kessler Psychological Distress Scale. Changes in labour force participation and health were examined with repeated-measures logistic regression analyses by the generalized estimating equations method. Results The interdisciplinary re-employment programme did not have a positive influence on entering employment or physical or mental health among unemployed persons with mental health problems. After 2 years, 10% of the participants of the intervention programme worked fulltime, compared to 4% of the participants of the usual programmes (adjusted OR 1.65). The observed differences in labour force participation were not statistically significant. However, among persons who entered paid employment, physical health improved (+16%) and anxiety and depressive symptoms decreased (-15%), whereas health remained unchanged among persons who continued to be unemployed. Conclusions Policies to improve population health should take into account that promoting paid employment may be an effective intervention to improve health. It is recommended to invest in interdisciplinary re-employment programmes with a first place and train approach.

Dataset Information

Does the effect of disability acquisition on mental health differ by employment characteristics? A longitudinal fixed-effects analysis.

Publications

Does the effect of disability acquisition on mental health differ by employment characteristics? A longitudinal fixed-effects analysis.

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