Nelson Richard E, Kim Jaewhan
Division of Epidemiology, University of Utah, Salt Lake City, UT 84148, USA.
J Ment Health Policy Econ. 2011 Mar;14(1):39-52.
Mental illness can adversely impact labor market outcomes in a variety of ways, through education attainment, employment possibilities, and income. However, little is known about the impact of mental illness on an individual's ability to maintain employment.
This paper examines the impact of mental health on the risk of employment termination. We also distinguish between voluntary and involuntary employment termination.
Using data from the Medical Expenditure Panel Survey, we used survival analysis techniques to examine the impact of a mental illness diagnosis on the risk of employment termination and propensity score matching techniques to construct similar comparison groups. Initially, we used Cox proportional-hazards models where the event of interest was termination of employment. We then used a competing risk framework to differentiate between voluntary and involuntary employment termination. We also stratified our analysis by gender and capture levels of severity, receipt of treatment, and specific type of mental illness.
We found that individuals with mental illness have an increased risk of employment termination in general as well as both involuntary and voluntary job loss. These results were consistent across all regression specifications.
This paper is the first to explore the association between mental illness and the risk of employment termination in a sample of employed individuals. Employment is closely linked with mental health. Evidence suggests that employment can improve an individual's mental well-being but that job loss can have a detrimental effect. Our results suggest that individuals that can greatly benefit from their jobs are precisely those who are at high risk of losing them. IMPLICATIONS FOR HEALTH CARE PROVISION AND POLICIES: A greater effort must be made to provide support networks for employees within their work environments. IMPLICATIONS FOR HEALTH CARE RESEARCH: Future analysis should examine the impact of antidepressant therapy, supported employment policies, and other mental health-related interventions on the risk of employment termination for those individuals with mental illness. This would be instructive for advocates of the mentally ill to design more targeted interventions for individuals at risk. In addition, future research should examine the effect of other health conditions on the risk of employment termination. In the present study, poor self-reported health increased the risk of involuntary job termination. It would be informative to isolate what types of ailments contribute to this increased risk.
精神疾病可通过教育程度、就业可能性和收入等多种方式对劳动力市场结果产生不利影响。然而，对于精神疾病对个人维持就业能力的影响却知之甚少。
本文考察心理健康对就业终止风险的影响。我们还区分了自愿和非自愿就业终止。
利用医疗支出面板调查的数据，我们使用生存分析技术来考察精神疾病诊断对就业终止风险的影响，并使用倾向得分匹配技术来构建相似的对照组。最初，我们使用Cox比例风险模型，其中感兴趣的事件是就业终止。然后，我们使用竞争风险框架来区分自愿和非自愿就业终止。我们还按性别进行分层分析，并考虑严重程度、接受治疗情况以及精神疾病的具体类型。
我们发现，患有精神疾病的个体总体上就业终止风险增加，包括非自愿和自愿失业。这些结果在所有回归设定中都是一致的。
本文首次在就业个体样本中探讨精神疾病与就业终止风险之间的关联。就业与心理健康密切相关。有证据表明，就业可以改善个人的心理健康，但失业可能产生不利影响。我们的结果表明，那些能从工作中极大受益的个体恰恰是面临高失业风险的人群。
必须做出更大努力，在工作环境中为员工提供支持网络。
未来的分析应考察抗抑郁治疗、支持性就业政策以及其他与心理健康相关的干预措施对患有精神疾病个体的就业终止风险的影响。这对于精神疾病倡导者为有风险的个体设计更具针对性的干预措施具有指导意义。此外，未来的研究应考察其他健康状况对就业终止风险的影响。在本研究中，自我报告的健康状况不佳会增加非自愿失业的风险。确定哪些类型的疾病导致了这种风险增加将很有意义。
