Leinonen Taina, Mäki Netta, Martikainen Pekka
Population Research Unit, Department of Social Research, University of Helsinki, Helsinki, Finland.
City of Helsinki Urban Facts, Helsinki, Finland.
PLoS One. 2017 Jan 5;12(1):e0169652. doi: 10.1371/journal.pone.0169652. eCollection 2017.
The unemployed more often suffer from depression than the employed. We examined whether mental health deterioration occurs already before unemployment implicating health selection, or whether it mostly occurs after becoming exposed to the experience rendering causal explanations more likely.
We used nationally representative Finnish register data to examine changes in depressive morbidity as measured by antidepressant medication in 1995-2009 over four years before and since a new onset of unemployment (N = 28 000) at the age of 30-60 compared to the employed (N = 124 136). We examined separately those who became continuously long-term unemployed, intermittently unemployed and unemployed with eventual re-employment in the second, third or fourth year since the year of onset. Annual repeated measurements were analysed using generalised estimation equations.
Among the employed antidepressant medication increased slowly but steadily over the study period and it was mainly at a lower level than among the unemployed. In the four years leading to unemployment there was excess increase in medication that was generally stronger among those with longer duration of the eventual unemployment experience. During unemployment medication decreased in all groups except among the intermittently unemployed. By the first year of re-employment antidepressant medication reached a level similar to that among the employed and afterwards followed no consistent trend.
The associations of unemployment and re-employment with depressive morbidity appear to be largely driven by health selection. The question of potential causal associations remains unresolved for intermittent unemployment in particular.
失业者比就业者更常患抑郁症。我们研究了心理健康恶化是在失业前就已出现，这意味着存在健康选择因素，还是主要在经历失业后出现，从而使因果解释更有可能成立。
我们使用具有全国代表性的芬兰登记数据，研究1995 - 2009年期间，30至60岁新出现失业情况（N = 28000）的人群在失业前后四年中与就业人群（N = 124136）相比，使用抗抑郁药物衡量的抑郁发病率变化。我们分别研究了那些在失业后第二年、第三年或第四年持续长期失业、间歇性失业以及最终再就业的失业者。使用广义估计方程分析年度重复测量数据。
在研究期间，就业人群中抗抑郁药物的使用缓慢但稳步增加，且主要处于低于失业人群的水平。在导致失业的四年中，药物使用过度增加，且在最终失业经历持续时间较长的人群中通常更为明显。在失业期间，除间歇性失业者外，所有组的药物使用量均下降。到再就业的第一年，抗抑郁药物的使用量达到与就业人群相似的水平，此后没有一致的趋势。
失业和再就业与抑郁发病率之间的关联似乎很大程度上是由健康选择因素驱动的。特别是间歇性失业的潜在因果关联问题仍未解决。
