Montgomery S M, Cook D G, Bartley M J, Wadsworth M E
University Department of Medicine, Royal Free Hospital School of Medicine, University of London, UK.
Int J Epidemiol. 1999 Feb;28(1):95-100. doi: 10.1093/ije/28.1.95.
There is evidence to support a link between unemployment and lower levels of psychological well-being, but debate continues as to whether unemployment results in psychological morbidity, or whether the association is due to those who are more vulnerable to mental illness becoming unemployed. Here we assess the effect of recent and accumulated unemployment in young men on the risk of developing depression and anxiety leading to medical consultation. Adjustment was made for a measure of pre-existing tendency to depression, behavioural maladjustment, social class, qualifications and region of residence.
Some 3241 men from the National Child Development Study (the 1958 British birth cohort) with data from birth to age 33 years, collected at birth and ages 7, 11, 16, 23 and 33 years were used in these analyses. The outcome measure was onset age of anxiety or depression between ages 24 and 33 years, that resulted in consultation with a GP or a specialist. This was used in Cox proportional hazards models where two measures of unemployment were modelled as time varying covariates. Pre-existing tendency to depression was measured by the Malaise Inventory prior to the experience of unemployment at age 23 years. Two measures of unemployment were investigated: any unemployment in the year prior to onset (recent unemployment) and all accumulated unemployment prior to onset (divided into four categories: 0, 1-12, 13-36 and 37+ months of unemployment).
After adjustment for potential confounding factors including pre-existing tendency to depression, the relative risk (RR) for developing symptoms resulting in consultation was 2.10 (95% CI: 1.21-3.63), when those who were unemployed in the year prior to onset were compared with those who were not. Accumulated unemployment was not statistically significantly related to onset of symptoms in all men after adjustment for the potential confounding factors: an RR of 1.63 (95% CI: 0.95-2.79) for men with 37+ months of accumulated unemployment when compared with none. However, exclusion of men with a pre-existing tendency to depression indicated by the Malaise Inventory score, increased the RR to 2.30 (95% CI: 1.44-3.65) for recent unemployment and 2.04 (95% CI: 1.17-3.54) for 37+ months of accumulated unemployment when compared with none.
Unemployment is a risk factor for psychological symptoms of depression requiring medical attention, even in those men without previous psychological vulnerability.
有证据支持失业与较低水平的心理健康之间存在联系，但关于失业是否会导致心理疾病，或者这种关联是否是由于那些更容易患精神疾病的人失业所致，仍存在争议。在此，我们评估近期和累积失业对年轻男性患抑郁症和焦虑症并导致就医风险的影响。对预先存在的抑郁倾向、行为失调、社会阶层、学历和居住地区等因素进行了调整。
来自全国儿童发展研究（1958年英国出生队列）的约3241名男性，其从出生到33岁的数据在出生时以及7岁、11岁、16岁、23岁和33岁时收集，用于这些分析。结局指标是24岁至33岁之间焦虑或抑郁的发病年龄，且发病后咨询过全科医生或专科医生。这一指标用于Cox比例风险模型，其中将两种失业指标作为随时间变化的协变量进行建模。在23岁失业之前，通过不适清单测量预先存在的抑郁倾向。研究了两种失业指标：发病前一年的任何失业（近期失业）以及发病前所有累积失业（分为四类：0、1 - 12、13 - 36和37个月以上失业）。
在对包括预先存在的抑郁倾向等潜在混杂因素进行调整后，将发病前一年失业的人与未失业的人相比，出现导致就医症状的相对风险（RR）为2.10（95%置信区间：1.21 - 3.63）。在对潜在混杂因素进行调整后，累积失业与所有男性的症状发作在统计学上无显著关联：与无累积失业者相比，累积失业37个月以上男性的RR为1.63（95%置信区间：0.95 - 2.79）。然而，排除不适清单评分显示有预先存在抑郁倾向的男性后，与无失业者相比，近期失业的RR增至2.30（95%置信区间：1.44 - 3.65），累积失业37个月以上的RR为2.04（95%置信区间：1.17 - 3.54）。
失业是需要就医的抑郁心理症状的一个风险因素，即使在那些先前没有心理易感性的男性中也是如此。
