Kiely Kim M, Butterworth Peter
Centre for Research on Ageing Health and Wellbeing, The Australian National University, , Canberra, Australian Capital Territory, Australia.
J Epidemiol Community Health. 2014 Apr;68(4):349-55. doi: 10.1136/jech-2013-203179. Epub 2013 Dec 10.
The higher occurrence of common psychiatric disorders among welfare recipients has been attributed to health selection, social causation and underlying vulnerability. The aims of this study were to test for the selection effects of mental health problems on entry and re-entry to working-age welfare payments in respect to single parenthood, unemployment and disability.
Nationally representative longitudinal data were drawn from the Household Income and Labour Dynamics in Australia survey. Multiple spell discrete-time survival analyses were conducted using multinomial logistic regression models to test if pre-existing mental health problems predicted transitions to welfare. Analyses were stratified by sex and multivariate adjusted for mental health problems, father's occupation, socioeconomic position, marital status, employment history, smoking status and alcohol consumption, physical function and financial hardship. All covariates were modelled as either lagged effects or when a respondent was first observed to be at risk of income support.
Mental health problems were associated with increased risk of entry and re-entry to disability, unemployment and single parenting payments for women, and disability and unemployment payments for men. These associations were attenuated but remained significant after adjusting for contemporaneous risk factors.
Although we do not control for reciprocal causation, our findings are consistent with a health selection hypothesis and indicate that mental illness may be a contributing factor to later receipt of different types of welfare payments. We argue that mental health warrants consideration in the design and targeting of social and economic policies.
福利领取者中常见精神障碍的发生率较高，这归因于健康选择、社会成因和潜在易感性。本研究的目的是检验心理健康问题对进入和重新进入工作年龄福利金领取的选择效应，涉及单亲家庭、失业和残疾情况。
具有全国代表性的纵向数据取自澳大利亚家庭收入与劳动力动态调查。使用多项逻辑回归模型进行多轮离散时间生存分析，以检验既往心理健康问题是否能预测向福利金领取的转变。分析按性别分层，并对心理健康问题、父亲职业、社会经济地位、婚姻状况、就业史、吸烟状况和饮酒量、身体功能以及经济困难进行多变量调整。所有协变量被建模为滞后效应或当首次观察到受访者有收入支持风险时的效应。
心理健康问题与女性进入和重新进入残疾、失业和单亲福利金领取以及男性进入和重新进入残疾和失业福利金领取的风险增加相关。在调整同期风险因素后，这些关联减弱但仍然显著。
尽管我们没有控制相互因果关系，但我们的研究结果与健康选择假说一致，表明精神疾病可能是后期领取不同类型福利金的一个促成因素。我们认为，在社会和经济政策的设计和目标设定中，心理健康值得考虑。
