Commentary: Do social programmes contribute to mental well-being? The long-term impact of unemployment on depression in the US

Jane E Ferrie

Department of Epidemiology and Public Health, University College London Medical School, 1–19 Torrington Place, London WC1E 6BT, UK. E-mail: j.ferrie{at}public-health.ucl.ac.uk

Using baseline (1987) and follow-up (1992) data from the National Survey of Families and Households (NSFH), Rodriguez et al. set out to examine the long-term consequences of different types of government benefit on the negative mental health impact of unemployment.1 The NSFH is a rich dataset which has enabled the authors to look at the short- and long-term effects of employment status and receipt of benefit, while controlling for depression score at baseline and numerous other factors that have been shown to be associated with employment status and depression, such as debt and social support. Research of this nature is important as few studies have explicitly examined the effects of government benefits on health outcomes using individual data.

The paper presents numerous findings, of which the authors choose to highlight the beneficial long-term effect of statutory benefits for mental health in unemployed women and the adverse short- and long-term effects of means-tested benefits in women who are non-employed, compared to women in full-time employment.

As many studies have convincingly linked the health effects of unemployment directly to financial problems2,3 the explanation of these findings which springs to mind is that means-tested benefits provide insufficient income to maintain mental health. However, the analyses are controlled for household income, assets and debts as well as measures of social support. The authors conclude that ‘social stigma and/or some other factors in the process associated with receiving welfare benefits could add additional stress to the lives of the recipients...’. Such effects were widely documented in England in the 1930s depression4,5 and again in the 1980s.6,7 However, these accounts also provide a very vivid picture of the economic hardship resulting from dependency on means-tested benefits. The corrosive effect of this hardship is experienced directly via limited access to consumer goods and indirectly through social exclusion.8 It thus seems likely that, in this population also, unrecorded material disadvantage, such as poor quality, overcrowded housing,9 or access to adequate services,10 makes a substantial contribution to the mental health differences between women in full-time employment and those on means-tested benefits. Findings from other epidemiological studies indicate that financial strain, which is particularly associated with long-term unemployment, has adverse effects on mental health.11,12

More surprising than the generally adverse associations between receipt of means-tested benefit and mental health are the apparently salutogenic long-term effects of statutory benefits for women. Statutory benefits are usually paid for a limited period and are dependent on having been in employment for a considerable period prior to job loss. Thus it is likely that these women had only been unemployed for a short time before the 1987 data collection. It is generally accepted that recent unemployment is associated with the steepest decline in mental health,13 although there is evidence that some improvement in mental health may occur immediately post-redundancy when job loss has been preceded by a period of uncertainty.14 However, the 14 women in this category have a depression index in 1992, 2.2 times lower than women in full-time employment. This salutogenic effect remains after controlling for 1992 age, education, marital status, race, limiting physical or mental illness, household characteristics including income and wealth, social support, job search history and environmental factors, and employment status, as well as index of depression and social support in 1987. However, the 37 women not working and not looking for a job but on statutory benefits in 1987, similarly have significantly lower depression scores at follow-up, although in the fully-adjusted model the difference is no longer significant. These findings lead to the conclusion that either these were exceptional women or that full-time employment has an adverse impact on mental health in certain women. Domestic responsibilities and caring have been shown to be important determinants of women's self-reported morbidity.15,16 Thus, for women who have been shouldering the burden of domestic responsibilities and caring in addition to full-time employment, a period of being at home on statutory benefits might well have positive implications for mental health. Furthermore, women's resilience to job loss is thought to be greater than men's because they have these alternative roles from which they derive a sense of self-worth.17

The other consistent conclusion to come out of the study, that part-time work has significant long-term benefits for men, also appears to support the argument that full-time employment has adverse effects on the mental health of some workers. The Second European Survey of Working Conditions found part-time and temporary workers to have significantly lower levels of stress than permanent full-time employees.18 One reason for this may lie in the work intensification which has accompanied the downsizing of workforces over the past two decades. The expectation that surviving workers expand their skills and responsibilities to cover for those dismissed has increased work pressures, which in turn have been shown to have adverse effects on mental health.19

When respondents in employment in 1992 are split by job satisfaction a clearer picture of the mental health damaging effects of unsatisfactory work are seen. Unsatisfactory full-time employment is associated with significantly higher depression scores for both sexes, as is unsatisfactory part-time employment in women. Dissatisfaction with employment can be due to many factors, but there is evidence that people most vulnerable to unemployment are also those most likely to be in poor quality insecure jobs.20

In general, both population and redundancy studies have found job insecurity and threat of job loss to be related to significant increases in mental ill-health.21,22 These effects are not transitory, but are increased by chronic exposure to the stressor.19,23 Robust evidence of the effect of insecure employment on psychological morbidity has come from a longitudinal study of white-collar British civil servants, the Whitehall II study. In analyses adjusted for age, socioeconomic position, marital status and pre-existing morbidity, women and men re-employed in insecure jobs after losing long-term secure employment in the Civil Service had significantly higher levels of mental ill-health than those able to find secure jobs.24 These findings complement those from other studies. Unsatisfactory re-employment following factory closure among male steel workers25 and car workers26 has been shown significantly to increase depression compared with satisfactory re-employment, whereas values for the unemployed fall between. Increased depression scores among unemployed men in the Social Change and Economic Life Initiative were not reduced by re-employment in an insecure job,27 and a longitudinal population study of young women and men found psychological disorder to be higher among dissatisfied workers than in the unemployed.28

Qualitative studies of unemployment have provided evidence that different personal positions can lead to contrasting attitudes to being unemployed. Studies, such as those by Little29 and Fineman,30 conclude that, in a sizeable minority, unemployment gives rise to positive feelings. Of the 100 middle-class unemployed in the Fineman study, one-third saw their unemployment as an opportunity to escape from boring or stressful jobs and find employment which could meet long-frustrated needs. Those who obtained such re-employment talked of the liberating experience and the renewed energy they had for their new job. However, those who did not were left feeling inadequate and threatened in ways they had not experienced before.30

Taken together such findings has led a number of researchers to conclude that ‘no job’ may be better than ‘any job’ and that cumulative labour market disadvantage may have more relevance for psychological well-being than unemployment alone.13,27,31

Acknowledgments

Jane Ferrie was supported by the Economic and Social Research Council (L128251046) during the preparation of this work.

Conflict of interest: None.

References

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23 Ferrie JE, Shipley MJ, Marmot MG, Stansfeld SA, Davey Smith G. Change in job security and health among British civil servants: the Whitehall II Study 2000 (Unpublished).

24 Ferrie JE, Martikainen P, Shipley MJ, Marmot M, Stansfeld SA, Davey Smith G. Job loss, job insecurity and health post-privatisation in white-collar workers. BMJ 2000 (in press).

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