Mental disorders prevalent among unemployed individuals

A significant association exists between unemployment and mental disorders, reveals a Singapore study.

This finding becomes even more alarming as the COVID-19 pandemic brings economic activities to a halt across nations due to lockdowns and changing consumer behaviour. Economists have also forecast a recession in many countries, with the resulting unemployment leading to considerable harm to human health if neglected. [https://www.nber.org/ papers/w27432; https://www.imf.org/en/Publications/WEO/Issues/2020/06/24/WEOUpdateJune2020]

“Clinicians should remain vigilant and consider the loss of employment a potential risk factor for adverse physical and mental health changes,” the researchers said.

“A focus on holistic recovery that includes augmentation of medications with interventions like cognitive behavioural therapy, problem-solving therapy, and work-directed interventions can facilitate re-entry into the workforce and improve health outcomes,” they added.

Data for this study were drawn from the Singapore Mental Health Study 2016, a household survey of a nationally representative sample of 6,126 Singapore residents. The researchers assessed mental disorders and physical health conditions using the Composite International Diagnostic Interview (CIDI) and collected employment-related information using a modified employment module of the CIDI.

Of the 6,125 participants, 4,055 (72 percent) were employed, 1,716 (22.7 percent) were economically inactive, and 354 (5.3 percent) were unemployed. The rate of unemployment was twofold higher among those with a 12-month mental disorder than those without (11.5 percent vs 4.8 percent), and the number of unemployed participants rose with increasing mental disorder severity. [Ann Acad Med Singap 2021;50:390-401]

Employed individuals were more likely to be married and have a higher household income than those who were unemployed. On the other hand, the presence of a 12-month mental disorder significantly correlated with a lower prospect of employment.

These results are consistent with those from studies conducted in Australia, Canada, and 27 European countries, suggesting that employment is essential to mental health across cultures. [Aust N Z J Psychiatry 2003;37:230-235; PLoS One 2013;8:e69792; http://www.ohrc.on.ca/en/numbers-statistical-profile-people-mental-health-and-addiction-disabilities-ontario]

“Industrialized societies are likely to gain several benefits from work, while specific benefits such as financial remuneration, social support, and status may vary across cultures and needs further research,” the researchers said. [Scand J Psychol 2015;56:659-669]

Of note, the most prevalent mental disorder in the unemployed group was major depressive disorder, whereas among those employed, obsessive-compulsive disorder was common.

Previous studies also showed that depression correlated with cognitive impairment and health problems, which could adversely affect job performance and lead to unemployment. The cross-sectional design of the current study, however, prevented researchers to infer on causality. [Sci Rep 2020;10:9740; Int J Environ Res Public Health 2019;16:1642]

“Given that depression is the most prevalent mental disorder in Singapore, the association with unemployment is even more concerning,” the researchers said. [Soc Psychiatry Psychiatr Epidemiol 2013;48:117-123; Int J Methods Psychiatr Res 2004;13:93-121]

“The results provide further evidence for the need to promote workplace mental health, which encompasses screening for mental distress and initiation of early antidepressant treatment, reducing functional impairments, and supporting continual employment,” they added. [J Affect Disord 2018;227:406-415]