Tag Archives: Depression

Youth unemployment and later mental ill-health: who is at risk?

The pandemic has brought links between unemployment and mental health to the fore. With joblessness having risen across the globe, new research looking at the longer-term effects is particularly timely. Liam Wright and colleagues from UCL’s Department of Epidemiology and Public health describe new research which could motivate efforts to target vulnerable groups and use resources efficiently.

We have known for some time that unemployment has a detrimental effect on mental health. And we know, too, that these effects can last for many years. A large body of research tells us those who have a spell out of work when young are more likely to suffer from poor wellbeing, depression and anxiety even decades later. 

It’s particularly useful to study these effects through the lens of youth unemployment, for two main reasons. First, unemployment rates are higher for those under 25 and recessions have a disproportionate effect on them. Second, unemployment at this formative stage of life may have a greater impact than unemployment later on: it can affect the way young people see themselves and can set off ‘chains of risk.’

Negative experiences during youth can have a measurable impact on our responses to stress, and that this can have a lifelong effect on our physical and mental health.

But until now we don’t know much about the reasons behind these links, or about whether these impacts were experienced differently by different groups of people. By learning more about these things, we should be able to direct resources more effectively to those who are likely to need extra help.

We decided to look at whether unemployment had a stronger association with later mental health for some individuals than others using a statistical technique called quantile regression. We also looked at whether the association was stronger for those with longer unemployment spells, was larger in men or women, and whether later employment success (which is thought to explain the association) was associated with relatively better mental health.

Mental health

We used data from Next Steps, formerly the Longitudinal Study of Young People in England, which followed a cohort of English school children who were aged 13 and 14 in 2003-4. The group were followed up to the age of 25– by that stage, there were 7,700 in our sample.

The mental health of the participants was measured at age 25 using the General Health Questionnaire or GHQ-12, a screening tool which can pick up mood and anxiety disorders and which scores them on a 36-point scale of seriousness – with 36 the most serious. We also took account of whether the respondents had a disability, their mental health during adolescence, as well as how they saw their general physical health.

We were able to compare these health scores with the employment status of the young people, focusing on those who had been unemployed for six months or more around the ages of 18 to 20 – this took place between 2008-10 and coincided with the global financial crisis, after which youth unemployment rose significantly.

We took account of a range of other factors such as gender, ethnicity, neighbourhood deprivation, educational attainment at age 25 and risk-taking behaviours such as drug-taking, alcohol, smoking and anti-social behaviour.

The results supported our key hypothesis that the association between youth unemployment and later mental health was driven by a relatively small proportion of formerly unemployed individuals who had very poor levels of mental health. Our model suggested that among a set of hypothetical individuals with average characteristics, more than 30 per cent of those who had been unemployed more than six months would have GHQ scores over 15 on the 36-point GHQ scale; 10 percentage points more than those who had not.

These effects could be seen even among those who were employed by age 25, and there was some evidence that the association was greater for men than for women.

Who’s at risk?

Our findings support and extend our existing knowledge, and they also pose questions: who are the individuals most at risk? We know men are more vulnerable in this respect than women, though this may be in part due to the greater likelihood that they are seeking work as opposed to looking after children, for example. But do men suffer more in economic, as opposed to mental health, terms?

We might also look at whether certain personality traits can help or hinder the wellbeing of those who find themselves unemployed while young. For example, does it help to feel that one has control over one’s own destiny, rather than taking a more fatalistic approach?

And we might look, too, at the mechanisms through which scarring takes place. Could unemployment while young affect people’s neuro-behavioural development? Or should we focus more on the ways in which an early spell of unemployment can cause problems later in the jobs market?

The answers to these questions could help us to identify vulnerable groups more accurately, and to point towards policy solutions which could potentially reduce these scarring effects in the future.

Heterogeneity in the Association Between Youth Unemployment and Mental Health Later in Life: A Quantile Regression Analysis of Longitudinal Data from English Schoolchildren, is research by  Liam Wright, Jenny Head and Stephen Jivraj of the Department of Epidemiology and Public Health, University College London, and is published in BMJ Open (http://dx.doi.org/10.1136/bmjopen-2020-047997).

Lockdown – just how stressful has it been?

2020 is a year many will be happy to see the back of. It has been a stressful time for sure with periods of lockdown creating major challenges for our day to day work and family lives. But have the stresses and strains associated with lockdown affected the mental health of the UK population as a whole? Tarani Chandola and colleagues have been using specially collected COVID19 data to investigate.

On March 23, the UK found itself in its first lockdown, a direct result of rising infection rates and deaths caused by the pandemic. The new normal for many was working from home whilst trying to homeschool children. The weekly shop involved queues and masks and social distancing. Getting a doctor or dentist appointment or scheduled medical treatment took on a whole new dimension. Trips to the pub, cinema and theatre were things people could no longer look forward to and looking out for elderly relatives and friends became more important and challenging in equal measure.

Gradually through the Summer months, many of these restrictions were eased and the majority of children returned to school. Businesses including pubs, gyms and hairdressers were able to re-open albeit with strict social distancing and hygiene measures in place.

The severity of the restrictions combined with the direct effects of the disease itself created what might be described as a perfect storm of increased potential stresses likely to adversely affect the mental health of people everywhere. Most of us will have felt fearful about catching the disease, and many will have experienced additional worries for already vulnerable family and friends. The realities of working at home brought its own challenges while for others being furloughed or losing their job brought additional anxiety. 

Although there have been widespread reports of worsening mental health and wellbeing through the first UK lockdown, there have also been some reports that this eased somewhat through April and May although not back to pre-pandemic levels.

COVID-19 data

In our research, which made use of data from Understanding Society including its specially-collected COVID-19 study, we were able to look across a slightly longer period of time at the experiences of between 13,000 and 17,000 people in the UK. These were people who had been involved in the survey for many years, so there was a great deal of background information available as a backdrop for our research. 

We wanted to see whether more people were reporting struggling with mental health problems and to what extent the prevalence of problems was directly related to the stresses and strains of lockdown and the pandemic specifically. We also wanted to see if, after the initial ‘shock’ of events in April eased in subsequent months as people began to adapt and ‘get used to’ their new circumstances.

Between April and July study participants were asked a range of questions directly related to the disease itself including whether they had had it, been tested for it or experienced symptoms. There were also questions about any other health treatment, their families, work and money- related concerns such as struggling to pay the bills.

Every month people were asked about their work status so we could see for example  who was employed, self-employed, working reduced hours, furloughed or been made redundant. They were also asked about hours spent on childcare and homeschooling or whether they felt lonely.

Common mental disorder

Before lockdown just under 25 per cent of people in the UK had experienced mental health issues and this rose to just over 37 per cent in April, so more than a third of the population. There was a gradual dropping off of cases through to July (just under 26 per cent) taking things almost back to pre-lockdown levels. 

The percentage of new cases of mental health problems among participants in April was double (around 28 percent) what it was in the preceding 12 months.

And recovery rates from a mental health issue dropped from pre-lockdown months through April to June but picked up again in July, by which time social restrictions had been eased considerably and, our research shows, potential stressors around COVID itself, juggling work and family responsibilities and health, business and money concerns had decreased for most.

The number of people who reported having some sort of health limiting condition and having to cancel or postpone medical treatment halved from April to July. Over the same period, the number of self-employed people who said their business had been adversely affected also went down from 3.6 percent to 0.6 percent. Employees who reported being made unemployed or being on reduced hours also more than halved and there was only a small increase in the proportion of people describing themselves as ‘economically inactive’. 

Rates of reporting ‘often feeling lonely’ went down from 8.8 to 6.7 percent and fewer people reported having to spend more than 16 hours a week on childcare or homeschooling although there was a small increase in the proportion of people spending 1-15 hours on those tasks.

For some people, problems with paying bills remained an issue throughout the period,  although the percentage of people who said they found things very difficult financially or who said the future looked bleaker financially reduced somewhat from April onwards. 

Which stresses affected people most?

The strongest link between lockdown related stress was loneliness. People in the survey who reported ‘often feeling lonely’ were 11 to 16 times more likely to have mental health problems from the April to July compared to those who never felt lonely. Other important stressors were having COVID-19 symptoms and always working from home. 

Self-employed people whose businesses were negatively impacted by COVID-19 were more likely to develop a mental health problem compared to their peers whose businesses were not. And by July, employees who became unemployed, or were made redundant or whose work hours were reduced were over two times as likely to develop a problem compared with those who were unaffected. 

Adults doing16 hours or more a week on childcare or home schooling were about 1.4 times more likely to develop a problem compared to those who had no children or did not spend any time on childcare. 

Adults who were finding it quite or very difficult financially were 2.4 times more likely to develop a mental health issue compared to those who were living comfortably. Similarly, adults who expected their future finances to be worse off than now were 1.6 times more likely.

Longitudinal analysis

Our findings from looking at this group of people across April to July are in line with other surveys undertaken by the Office of National Statistics and the UCL COVID-19 study of 90,000 adults. We add to that picture by looking more closely at which stressful circumstances are most likely to drive up incidences of poor mental health during a pandemic of this nature. 

We conclude that despite the lifting of many lockdown conditions by July and a decrease in the levels of many of the psychological and social stressors, these stressors continued to drive poor mental health among people who were lonely and those who were made unemployed or redundant, had financial problems or had childcare or home schooling duties.

As unemployment and redundancy increase in the labour market, an inevitable result of recent events, it will be important to keep monitoring the mental health consequences of unemployment. It is Interesting also to note that employees who were furloughed had about the same levels of mental health problems as employees whose job hours were not affected. This suggests that the government measures to protect jobs also had positive mental health benefits for those employees who were able to keep their jobs albeit in a “furloughed” state.

The mental health impact of COVID-19 and lockdown-related stressors among adults in the UK is research by Tarani Chandola, Cara Booker, Meena Kumari and Michaela Benzeval and  is published in Psychological Medicine

Young woman sat by window

Are some types of job bad for your mental health? And how can employers ensure poor mental health does not lead to early retirement?

Mental illness is a major cause of early retirement – but do those who are forced to leave work early for this reason get better afterwards? What is the relationship between work stress and mental health? A new study of public sector workers in Finland suggests there is a link – and there are important lessons for employers. Tarani Chandola from the ESRC International Centre for Lifecourse Studies was among the authors of the study.

One way in which we can track the prevalence and level of mental illness is by looking at the use of psychotropic medication – that is, medication which can alter one’s mental state. This group of drugs includes common antidepressants, anti-anxiety drugs and antipsychotic medication. 

If there is a link between work stress and mental illness, then we should expect those forced to leave work for this reason to get better after retirement. So by tracking the levels of psychotropic medication among a group of workers before and after retirement, we could find out the extent to which there was such a link.

We were able to use data from a long-term study of Finnish public sector workers to examine the issue more closely. 

It matters because previous studies have shown an increase in the use of this group of drugs among all those who take disability retirement, particularly those whose retirement was due to mental ill health. Those from higher social classes saw the biggest drop in medication use after retirement, suggesting there are social factors at play here, too.

Global issues

The effect does seem to vary around the globe, though – some studies from Asia found an increase, rather than a decrease, in mental health problems after leaving work. But in Europe, retirement has often been found to be followed by an improvement in both mental and physical health. Retirees have reported sleeping better, feeling less tired and generally feeling a greater sense of wellbeing. 

We were able to use data from the Finnish Public Sector study cohort study, which followed all employees working in one of 10 towns and six hospital districts between 1991 and 2005. The study included participants from a wide range of occupations including administrative staff, cleaners, cleaners and doctors, and they were followed up at four-year intervals regardless of whether they were still in the same jobs. Their survey responses were linked to a register of medication purchases for at least two years before retirement and two years after.

We had information on 2,766 participants who took retirement because of disability. Uniquely, the data included both participants’ use of medication and their perceived levels of work stress. So we were able to ask whether there were differences in this pre and post-retirement effect between those in low and high-stress jobs.

Specifically, we looked at something called effort-reward imbalance – that is, when workers put in too much effort at work but get few rewards in compensation: according to a recent review, this carries an increased risk of depressive illness. 

If our theories were correct, we would see a decline in the use of psychotropic medication after disability retirement, and it would be greatest among those with high levels of effort-reward imbalance. Along with mental illness the other major cause of disability retirement in Finland is musculoskeletal disease, so we categorised our sample in three groups – mental illness, musculoskeletal disease and ‘other.’ Eight out of 10 in the sample were women, and three out of 10 reported high effort-reward imbalance before retirement.

Unsurprisingly, those who retired due to a mental disorder had the greatest increase in psychotropic drug use before retirement. And those who were in high-stress, low-reward jobs had higher levels of medication use than those who were not. But after retirement, there was no difference in psychotropic drug use between those with high vs low effort-reward imbalance. It looked as though stopping work in high stress jobs reduced the need for higher psychotropic medication use among those workers who exited the labour market for mental health reasons.  

Retirement because of musculoskeletal disease or other causes was not associated with any similar link between stress level and psychotropic medication.

Lessons for employers

Our study showed that among people retiring due to mental disorders, those in high-stress, low-reward jobs benefited most from retirement. So it’s likely that they could benefit from the alleviation of work-related stress before retirement, too.

In conclusion, if employers could find ways of reducing the levels of stress suffered by employees suffering from mental ill-health, their early exit from paid employment might be prevented and their working lives might be extended. 

Psychotropic medication before and after disability retirement by pre-retirement perceived work-related stress was published in the European Journal of Public Health, Vol. 0, No. 0, 1–6. 

The other authors were Jaana Halonen, Taina Leinonen, Ville Aalto, Tuula Oksanen, Mika Kivimäki and Tea Lallukka of the Finnish Institute of Occupational Health; Hugo Westerlund and Marianna Virtanen of the Stress Research Institute, Stockholm University; Martin Hyde of the Centre for Innovative Ageing, Swansea University; Jaana Pentti, Sari Stenholm and Jussi Vahtera of the Department of Public Health, University of Turku; Minna Mänty of the Department of Public Health, University of Helsinki; Mikko Laaksonen of the Research Department, Finnish Center for Pension.

These authors also have the following additional affiliations: Jaana Halonen; Stress Research Institute, Stockholm University; Jaana Pentti; Department of Public Health, University of Turku; Minna Mänty; Statistics and Research, City of Vantaa, Finland; Mika Kivimäki, Department of Public Health, University of Helsinki and Department of Epidemiology and Public Health, University College London; Marianna Virtanen, School of Educational Sciences and Psychology, University of Eastern Finland, Joensuu; Tea Lallukka, Department of Public Health, University of Helsinki.

Woman worker

Anti-social working hours: Are they making women depressed?

The rise of globalisation and the 24/7 economy are fuelling demands for people to work long hours and weekends.  But what’s the evidence about how these ways of working link with depression? Gill Weston and colleagues from the International Centre for Lifecourse Studies in Society and Health at UCL and Queen Mary University of London found such working conditions are linked to poorer mental health in women. 

Across the globe, the effects of overwork are becoming apparent.  In eastern Asian countries the risk of death due to overwork has increased.  In the UK, work-related stress accounts for millions of lost working days every year.  

Within the EU, a significant proportion of people have to work unsociable hours – with nearly a quarter working most Saturdays and a third working at least one Sunday a month.  But despite this, there isn’t much clear evidence about the links between work patterns and mental health. 

Some studies have found a connection between unsociable work patterns and depression.  But many of the studies only focused on men, some only looked at specific types of worker or workplaces and few took account of work conditions such as whether workers had any control over how fast they worked.  

To address these gaps, we set out to look for links between long or irregular hours and depression using a large nationally representative sample of working men and women in the UK.  We particularly wanted to look at whether there were differences between men and women because research has shown that work is organised, experienced and rewarded differently for men and women, and because men and women react differently to overwork and time pressure. 

We used data from Understanding Society, which surveys people living in 40,000 households across the UK.  In particular we focused on information about working hours, weekend working and working conditions collected from 11,215 working men and 12,188 working women between 2010 and 2012.  They had completed a questionnaire designed to study levels of psychological distress.

Who works the most? 

We found men tended to work longer hours in paid work than women, and having children affected men’s and women’s work patterns in different ways: while mothers tended to work fewer hours than women without children, fathers tended to work more hours than men without children.  

Two thirds of all men worked weekends, compared with half of all women.  Those who worked all or most weekends were more likely to be in low skilled work and to be less satisfied with their job and their earnings than those who only worked Monday to Friday or some weekends 

Which workers have the most depressive symptoms? 

Women in general are more likely to be depressed than men, and this was no different in our study. 

Independent of their working patterns, we also found that workers with the most depressive symptoms were older, smokers, on lower incomes, in physically demanding jobs, and who were dissatisfied at work. 

Are long and irregular hours linked to depression? 

Taking these findings and other factors into account, when we looked at the mental health effects of work patterns on men and on women, the results were striking: while there was little or no difference in depressive symptoms between men who worked long hours and those who did not, this was not the case for women.   

Those women who worked 55 hours or more per week had a higher risk of depression than women working a standard 35-40 hour week.   

Similarly weekend working showed differences for men and women.  Compared to workers who only worked on weekdays, men who worked weekends also had a greater number of depressive symptoms, but only if they had little control at work or were dissatisfied with work.  Whereas for women,  regardless of their control or satisfaction, working most or all weekends was linked to more depressive symptoms. 

Why might women suffer more than men while working these antisocial hours?  

There might be a number of reasons why women might be more affected than men: 

  • Women who work long hours are in a minority – just four per cent of them in our sample worked 55 hours or more per week. This may place them under additional pressure. 
  • Women working longer hours tend to be in male-dominated occupations, and this may also contribute to stress. 
  • Women working weekends tend to be concentrated in low-paid service sector jobs, which have been linked to higher levels of depression. 
  • Many women face the additional burden of doing a larger share of domestic labour than men, leading to extensive total work hours, added time pressures or overwhelming responsibilities.  

What should be done about these risks? 

Our findings should encourage employers and policy-makers to think about how to reduce the burdens and increase support for women who work long or irregular hours – without restricting their ability to work when they wish to.  More sympathetic working practices could bring benefits both for workers and for employers – of both sexes. 

Long work hours, weekend working and depressive symptoms in men and women: Findings from a UK population-based study by Gill Weston, Afshin Zilanawala, Elizabeth Webb, Livia Carvalho, and Anne McMunn is published in the  Journal of Epidemiology and Community Health, which is published by the BMJ. 

Does having a rotten job in middle age leave us depressed in retirement?

People’s working conditions have been high up the news agenda recently and not just in non European parts of the world either. Understandably, considerable concern has been expressed about the impact that low paid jobs with poor and uncertain conditions have on workers’ lives. But what are the impacts of poor or stressful working conditions and job uncertainty on people’s mental health further down the line once they stop working? Morten Wahrendorf from University of Düsseldorf in Germany and colleagues at the ESRC International Centre for Lifecourse have carried out research across Europe and found that those with poor jobs and working conditions in mid life are considerably more likely to suffer with depression after they retire.

Right across Europe people are living longer – on the face of it – a good thing. Unfortunately, for many, that increased life expectancy is accompanied by extended periods of poor health or disability – both physical and mental. The consequences of this are deeply worrying for policy makers funding services to care for people, overstretched health professionals and, of course for people themselves and their families.

It’s really important, therefore, to get a better handle on what goes on in our lives before we retire that might be linked to this later poor health. If we can identify what might lie behind it, we are more likely to be able to make changes and put things in place that reduce the risk for future generations.

The research looked at the mental health of nearly 5000 men and 4000 women with an average age of around 70 in 13 European countries and then looked back at their working lives in mid life to see what picture might emerge.

Using information from the Survey of Health, Ageing and Retirement in Europe (SHARE), we looked at how stressful their job had been both physically and mentally, how well rewarded and supported they felt, whether they had been laid off or had a period of unemployment. We used a special set of questions asked in the survey to identify whether or not the participants showed signs of depression.

Physically and mentally demanding work

More then a quarter of the men and a fifth of the women reported their job had been highly physically and/or highly mentally demanding. The proportion of women who worked in low-skilled jobs was lower among women compared with men (80 per cent women, 68 per cent men).

With regard to stressful conditions at work, 15 per cent of men and 23 per cent of women said they had had low levels of control at work. 20 per cent of men and 27 per cent of women said the rewards were low and 17 per cent of men and 20 per cent of women said they received low levels of social support.

When we linked their earlier working life to their mental health in retirement, both men and women who had previously worked in mentally stressful jobs were more likely to exhibit signs of depression later on. For men, the strongest links with depression were for those who reported having jobs with a low level of control, whilst for women it was jobs with low levels of social support.

Both men and women who had worked in poor quality jobs were considerably more likely to be depressed than their peers with good jobs. Unsurprisingly, those people who had been unexpectedly laid off from a job in mid life were also more likely to be depressed later. Surprisingly, though unemployment and a fragmented career were associated with depression in men only.

The results stayed strong even after taking account of the workers’ health and social circumstances before middle age.

Clear and robust link

The research reinforces a number of studies drawing a clear and robust link between poor mental health in later life and a disadvantaged working life in middle age, whether that be in terms of working environment or job uncertainty. What’s new here though is tracing that link over people’s lifecourse from middle age into retirement. The research also shows some important and interesting distinctions between men and women.

There is a clear message here too for policy makers, business and health professionals that mid-life is a critical period where appropriate interventions and employment-related policies, such as lifelong learning programmes, through programmes increasing job security, or even mindfulness training, could bring significant benefits to individuals and society more widely, especially in the undeniable context of us all living and working longer.

Working conditions in mid-life and mental health in older ages is research by Morten Wahrendorf, David Blane, Mel Bartley, Nico Dragano and Johanes Siegrist and is published in Advances in Life Course Research.

Photo credit: World Bank