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Long-term effects of mental disorders on employment in the National Comorbidity Survey ten-year follow-up

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Abstract

Purpose

Although significant negative associations of mental disorders with employment have been documented in epidemiological research, much of this research was based on cross-sectional samples and focused only on severe and persistent mental disorders. The present study examined the longitudinal associations of more common mental disorders with employment.

Methods

Data on the associations of common mental disorders with employment are presented here from 4501 respondents in the National Comorbidity Survey panel study, a two-wave community epidemiological survey of respondents aged 15–54 at baseline (1990–1992) who were re-interviewed in 2001–2003 and were employed, unemployed in the labor force or student at baseline. Lifetime mental disorders at baseline and disorders with onset after baseline were assessed with the Composite International Diagnostic Interview, a fully structured interview that assessed lifetime prevalence of internalizing fear disorders (panic, phobias), anxiety/misery disorders (major depression, generalized anxiety disorder, post-traumatic stress disorder), externalizing disorders (conduct disorder, alcohol and illicit drug abuse-dependence), and bipolar disorder.

Results

Both baseline lifetime disorders and disorders with onsets after baseline were associated with significantly reduced odds of subsequent employment among respondents who were either employed or students at baseline. Population projections based on the assumption that these associations represented causal effects suggest that the mental disorders considered here were associated with 1.7–3.2 million adults being unemployed in the US population at follow-up.

Conclusions

Expanded access to treatment among current employees and students with mental disorders might lead to improved employment outcomes in these segments of the population.

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References

  1. Rice DP (1967) Estimating the cost of illness. Am J Public Health N Health 57(3):424–440

    Article  CAS  Google Scholar 

  2. Wing J (1970) Unemployment among chronic psychotic patients in Camberwell: their need for rehabilitation. Proc R Soc Med 63(12):1329

    PubMed Central  CAS  PubMed  Google Scholar 

  3. Lapouse R, Monk MA, Terris M (1956) The drift hypothesis and socioeconomic differentials in schizophrenia. Am J Public Health N Health 46(8):978–986

    Article  CAS  Google Scholar 

  4. Drake RE, McHugo GJ, Becker DR, Anthony WA, Clark RE (1996) The New Hampshire study of supported employment for people with severe mental illness. J Consult Clin Psychol 64(2):391–399

    Article  CAS  PubMed  Google Scholar 

  5. Miettunen J, Lauronen E, Veijola J, Koponen H, Saarento O, Taanila A, Isohanni M (2007) Socio-demographic and clinical predictors of occupational status in schizophrenic psychoses—follow-up within the Northern Finland 1966 Birth Cohort. Psychiatry Res 150(3):217–225

    Article  PubMed  Google Scholar 

  6. Cook JA (2006) Employment barriers for persons with psychiatric disabilities: update of a report for the President’s Commission. Psychiatry Serv 57(10):1391–1405

    Article  Google Scholar 

  7. Lerner D, Adler DA, Chang H, Lapitsky L, Hood MY, Perissinotto C, Reed J, McLaughlin TJ, Berndt ER, Rogers WH (2004) Unemployment, job retention, and productivity loss among employees with depression. Psychiatry Serv 55(12):1371

    Article  Google Scholar 

  8. Waghorn G, Chant D (2005) Labour force activity by people with depression and anxiety disorders: a population level second order analysis. Acta Psychiatry Scand 112(6):415–424

    Article  CAS  Google Scholar 

  9. Ettner SL, Frank R, Kessler RC (1997) The impact of psychiatric disorders on labor market outcomes. National Bureau of Economic Research Cambridge, Mass, USA

  10. Lerner D, Henke RM (2008) What does research tell us about depression, job performance, and work productivity? J Occup Environ Med 50(4):401

    Article  PubMed  Google Scholar 

  11. Savoca E, Rosenheck R (2000) The civilian labor market experiences of Vietnam-era veterans: the influence of psychiatric disorders. J Ment Health Policy Econ 3(4):199–207

    Article  PubMed  Google Scholar 

  12. Karpansalo M, Kauhanen J, Lakka T, Manninen P, Kaplan G, Salonen J (2005) Depression and early retirement: prospective population based study in middle aged men. J Epidemiol Community Health 59(1):70

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Mechanic D, Blider S, McAlpine DD (2002) Employing persons with serious mental illness. Health Aff 21(5):242–253

    Article  Google Scholar 

  14. Knudsen AK, Overland S, Hotopf M, Mykletun A (2012) Lost working years due to mental disorders: an analysis of the Norwegian disability pension registry. PLoS One 7(8):e42567

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Druss BG, Hwang I, Petukhova M, Sampson NA, Wang PS, Kessler RC (2009) Impairment in role functioning in mental and chronic medical disorders in the United States: results from the National Comorbidity Survey Replication. Mol Psychiatry 14(7):728–737

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  16. Lagerveld SE, Bultmann U, Franche RL, van Dijk FJ, Vlasveld MC, van der Feltz-Cornelis CM, Bruinvels DJ, Huijs JJ, Blonk RW, van der Klink JJ, Nieuwenhuijsen K (2010) Factors associated with work participation and work functioning in depressed workers: a systematic review. J Occup Rehabil 20(3):275–292

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  17. Kessler RC, Barber C, Birnbaum HG, Frank RG, Greenberg PE, Rose RM, Simon GE, Wang P (1999) Depression in the workplace: effects on short-term disability. Health Aff 18(5):163–171

    Article  CAS  Google Scholar 

  18. Tsutsumi A, Kayaba K, Theorell T, Siegrist J (2001) Association between job stress and depression among Japanese employees threatened by job loss in a comparison between two complementary job-stress models. Scand J Work Environ Health 27(2):146–153

    Article  CAS  PubMed  Google Scholar 

  19. Greenberg PE, Kessler RC, Birnbaum HG, Leong SA, Lowe SW, Berglund PA, Corey-Lisle PK (2003) The economic burden of depression in the United States: how did it change between 1990 and 2000? J Clin Psychiatry 64(12):1465–1475

    Article  PubMed  Google Scholar 

  20. Wang PS, Simon GE, Avorn J, Azocar F, Ludman EJ, McCulloch J, Petukhova MZ, Kessler RC (2007) Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. JAMA 298(12):1401–1411

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  21. Kessler RC, Merikangas KR, Wang PS (2008) The prevalence and correlates of workplace depression in the national comorbidity survey replication. J Occup Environ Med 50(4):381–390

    Article  PubMed Central  PubMed  Google Scholar 

  22. Simmons LA, Swanberg JE (2009) Psychosocial work environment and depressive symptoms among US workers: comparing working poor and working non-poor. Soc Psychiatry Psychiatr Epidemiol 44(8):628–635

    Article  PubMed  Google Scholar 

  23. Birnbaum HG, Kessler RC, Kelley D, Ben-Hamadi R, Joish VN, Greenberg PE (2010) Employer burden of mild, moderate, and severe major depressive disorder: mental health services utilization and costs, and work performance. Depress Anxiety 27(1):78–89

    Article  PubMed  Google Scholar 

  24. Dietrich S, Deckert S, Ceynowa M, Hegerl U, Stengler K (2012) Depression in the workplace: a systematic review of evidence-based prevention strategies. Int Arch Occup Environ Health 85(1):1–11

    Article  PubMed  Google Scholar 

  25. Montgomery SM, Cook DG, Bartley MJ, Wadsworth ME (1999) Unemployment pre-dates symptoms of depression and anxiety resulting in medical consultation in young men. Int J Epidemiol 28(1):95–100

    Article  CAS  PubMed  Google Scholar 

  26. Backhans MC, Hemmingsson T (2012) Unemployment and mental health—who is (not) affected? Eur J Pub Health 22(3):429–433

    Article  Google Scholar 

  27. Kessler RC, McGonagle KA, Zhao S, Nelson CB, Hughes M, Eshleman S, Wittchen HU, Kendler KS (1994) Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States. Results from the National Comorbidity Survey. Arch Gen Psychiatry 51(1):8–19

    Article  CAS  PubMed  Google Scholar 

  28. Borges G, Angst J, Nock MK, Ruscio AM, Kessler RC (2008) Risk factors for the incidence and persistence of suicide-related outcomes: a 10-year follow-up study using the National Comorbidity Surveys. J Affect Disord 105(1):25–33

    Article  PubMed Central  PubMed  Google Scholar 

  29. Rubin DB (2010) Propensity score methods. Am J Ophthalmol 149(1):7–9

    Article  PubMed  Google Scholar 

  30. Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier DA et al (1988) The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45(12):1069–1077

    Article  CAS  PubMed  Google Scholar 

  31. Kessler RC, Ustun TB (2004) The World Mental Health (WMH) survey initiative version of the World Health Organization (WHO) composite international diagnostic interview (CIDI). Int J Methods Psychiatr Res 13(2):93–121

    Article  PubMed  Google Scholar 

  32. Krueger RF (1999) The structure of common mental disorders. Arch Gen Psychiatry 56(10):921–926

    Article  CAS  PubMed  Google Scholar 

  33. Krueger RF, Caspi A, Moffitt TE, Silva PA (1998) The structure and stability of common mental disorders (DSM-III-R): a longitudinal-epidemiological study. J Abnorm Psychol 107(2):216–227

    Article  CAS  PubMed  Google Scholar 

  34. Spitzer RL, Williams JB, Gibbon M, First MB (1992) The structured clinical interview for DSM-III-R (SCID). I: history, rationale, and description. Arch Gen Psychiatry 49(8):624–629

    Article  CAS  PubMed  Google Scholar 

  35. First MB, Spitzer RL, Gibbon M, Williams JBW (2002) Structured clinical interview for DSM-IV Axis I Disorders, research version, non-patient edition (SCID-I/NP). New York, Biometrics Research, New York State Psychiatric Institute

    Google Scholar 

  36. Kessler RC, Wittchen HU, Abelson JM, Mcgonagle K, Schwarz N, Kendler KS, Knäuper B, Zhao S (1998) Methodological studies of the composite international diagnostic interview (CIDI) in the US national comorbidity survey (NCS). Int J Methods Psychiatr Res 7(1):33–55

    Article  Google Scholar 

  37. Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Lepine JP, Mazzi F, Reneses B, Vilagut G, Sampson NA, Kessler RC (2006) Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 15(4):167–180

  38. Northridge ME (1995) Public health methods—attributable risk as a link between causality and public health action. Am J Public Health 85(9):1202–1204

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  39. Howden LM, Meyer JA (2011) Age and sex composition. 2010 Census Briefs. United States Census Bureau. http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf

  40. Wolter KM (2007) Introduction to variance estimation. Statistics for social and behavioral sciences, 2nd edn. Springer, New York

  41. Research Triangle Institute (2004) SUDAAN: Professional software for survey data analysis, 9.0. Research Triangle Institute, Research Triangle Park, NC

  42. Kessler RC, Frank RG (1997) The impact of psychiatric disorders on work loss days. Psychol Med 27(04):861–873

    Article  CAS  PubMed  Google Scholar 

  43. Judd LL, Schettler PJ, Solomon DA, Maser JD, Coryell W, Endicott J, Akiskal HS (2008) Psychosocial disability and work role function compared across the long-term course of bipolar I, bipolar II and unipolar major depressive disorders. J Affect Disord 108(1):49–58

    Article  PubMed  Google Scholar 

  44. Greenberg PE, Sisitsky T, Kessler RC, Finkelstein SN, Berndt ER, Davidson JR, Ballenger JC, Fyer AJ (1999) The economic burden of anxiety disorders in the 1990s. J Clin Psychiatry 60(7):427–435

    Article  CAS  PubMed  Google Scholar 

  45. Wang PS, Simon GE, Kessler RC (2008) Making the business case for enhanced depression care: the National Institute of Mental Health-Harvard Work Outcomes Research and Cost-effectiveness Study. J Occup Environ Med 50(4):468–475

    Article  PubMed  Google Scholar 

  46. Green JG, McLaughlin KA, Alegria M, Costello EJ, Gruber MJ, Hoagwood K, Leaf PJ, Olin S, Sampson NA, Kessler RC (2013) School mental health resources and adolescent mental health service use. J Am Acad Child Adolesc Psychiatry 52(5):501–510

    Article  PubMed Central  PubMed  Google Scholar 

  47. Chung H, Klein MC, Silverman D, Corson-Rikert J, Davidson E, Ellis P, Kasnakian C (2011) A pilot for improving depression care on college campuses: results of the College Breakthrough Series-Depression (CBS-D) Project. J Am Coll Health 59(7):628–639

    Article  PubMed  Google Scholar 

  48. Hawken LS, Horner RH (2003) Evaluation of a targeted intervention within a schoolwide system of behavior support. J Behav Educ 12(3):225–240

    Article  Google Scholar 

  49. Magee WJ, Eaton WW, Wittchen H-U, McGonagle KA, Kessler RC (1996) Agoraphobia, simple phobia, and social phobia in the National Comorbidity Survey. Arch Gen Psychiatry 53(2):159–168

    Article  CAS  PubMed  Google Scholar 

  50. Wang PS, Demler O, Kessler RC (2002) Adequacy of treatment for serious mental illness in the United States. Am J Public Health 92(1):92–98

    Article  PubMed Central  PubMed  Google Scholar 

  51. US Bureau of Labor Statistics (2015) Labor force statistics from the current population survey. US Bureau of Labor Statistics. http://data.bls.gov/pdq/SurveyOutputServlet. Accessed 23 May 2015

  52. Evans-Lacko S, Knapp M, McCrone P, Thornicroft G, Mojtabai R (2013) The mental health consequences of the recession: economic hardship and employment of people with mental health problems in 27 European countries. PLoS ONE 8(7):e69792

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  53. US Bureau of Labor Statistics (2015) Local area unemployment statistics. http://www.bls.gov/lau/#tables. Accessed 23 May 2015

  54. Kessler RC, Heeringa S, Lakoma MD, Petukhova M, Rupp AE, Schoenbaum M, Wang PS, Zaslavsky AM (2008) Individual and societal effects of mental disorders on earnings in the United States: results from the national comorbidity survey replication. Am J Psychiatry 165(6):703–711

    Article  PubMed Central  PubMed  Google Scholar 

  55. Levinson D, Lakoma MD, Petukhova M, Schoenbaum M, Zaslavsky AM, Angermeyer M, Borges G, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Haro JM, Hu C, Karam AN, Kawakami N, Lee S, Lepine JP, Browne MO, Okoliyski M, Posada-Villa J, Sagar R, Viana MC, Williams DR, Kessler RC (2010) Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys. Br J Psychiatry 197(2):114–121

    Article  PubMed Central  PubMed  Google Scholar 

  56. Goldberg RJ, Steury S (2001) Depression in the workplace: costs and barriers to treatment. Psychiatr Serv 52(12):1639–1643

    Article  CAS  PubMed  Google Scholar 

  57. Eisenberg D, Golberstein E, Gollust SE (2007) Help-seeking and access to mental health care in a university student population. Med Care 45(7):594–601

    Article  PubMed  Google Scholar 

  58. Eisenberg D, Chung H (2012) Adequacy of depression treatment among college students in the United States. Gen Hosp Psychiatry 34(3):213–220

    Article  PubMed  Google Scholar 

  59. Hunt J, Eisenberg D (2010) Mental health problems and help-seeking behavior among college students. J Adolesc Health 46(1):3–10

    Article  PubMed  Google Scholar 

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Acknowledgments

The secondary analysis of the NCS/NCS-2 data reported here was supported by National Institute of Mental Health (NIMH) (RM PI; grant number R01MH096826). The NCS data collection was also supported by NIMH (RCK PI; grant number R01MH46376), while NCS-2 data collection was supported by the National Institute on Drug Abuse (RCK PI; grant number R01DA012058). The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or US Government. A complete list of NCS and NCS-2 publications can be found at http://www.hcp.med.harvard.edu/ncs. The NCS-2 is carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. These activities were supported by the NIMH (R.C.K., grant number R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R.C.K., grant numbers R13MH066849, R01MH069864, and R01DA016558), the Fogarty International Center (R.C.K., R03TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, and Bristol-Myers Squibb. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.

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Authors and Affiliations

  1. Department of Mental Health, Bloomberg School of Public Health, The Johns Hopkins University, 624 North Broadway, Room 797, Baltimore, MD, 21205, USA

    Ramin Mojtabai, Elizabeth A. Stuart, Ryoko Susukida & William W. Eaton

  2. Department of Health Care Policy, Harvard Medical School, Boston, MA, USA

    Irving Hwang, Nancy Sampson & Ronald C. Kessler

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  1. Ramin Mojtabai
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  2. Elizabeth A. Stuart
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  3. Irving Hwang
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  4. Ryoko Susukida
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  5. William W. Eaton
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  6. Nancy Sampson
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  7. Ronald C. Kessler
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Corresponding author

Correspondence to Ramin Mojtabai.

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Conflict of interest

Dr. Mojtabai has received research funding from Bristol Myers-Squibb and Lundbeck pharmaceuticals. In the past 12 months, Dr. Kessler has served as a consultant for Hoffmann-La Roche, Inc. and the Johnson & Johnson Wellness and Prevention. Dr. Kessler has served on advisory boards for Mensante Corporation, Johnson & Johnson Services Inc. Lake Nona Life Project, and US Preventive Medicine. Dr. Kessler owns 25 % share in DataStat, Inc. Other authors declare no potential conflict of interest.

Ethical standards

Original collection of NCS and NCS-2 data has been approved by the Institutional Review Board of Harvard University and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The analyses reported here have been approved by the Institutional Review Board of Johns Hopkins University, Bloomberg School of Public Health. All persons interviewed for NCS and NCS-2 surveys gave their informed consent prior to their inclusion in the study.

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Mojtabai, R., Stuart, E.A., Hwang, I. et al. Long-term effects of mental disorders on employment in the National Comorbidity Survey ten-year follow-up. Soc Psychiatry Psychiatr Epidemiol 50, 1657–1668 (2015). https://doi.org/10.1007/s00127-015-1097-z

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