Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Centre for Health Policy, School of Population and Global Health, University of Melbourne, Melbourne, Australia.
Int J Epidemiol. 2018 Oct 1;47(5):1423-1431. doi: 10.1093/ije/dyy128.
Young people with low education have worse health than those with higher education. This paper examined the extent to which employment and income reduced the adverse effects of low education on mental health among people aged 20-35 years.
We used causal mediation analyses to estimate the total causal effect (TCE) of low education on mental health and to decompose the effect into the natural direct effect (NDE) and the natural indirect effect (NIE) through two mediators examined sequentially: employment (labour-force participation/occupation skill level) and income. Three waves of the Household, Income and Labour Dynamics in Australia (HILDA) survey (2012-14) were used to establish a temporal sequence between low education (not completing high school), mediators and mental health [the Mental Health Inventory (MHI-5)] among participants aged 20-35 years. Among those who were employed, we conducted further analyses examining the effect of job characteristics as a mediator of the relationship between low education and mental health.
The TCE of low education on the MHI-5 was -3.61 [95% confidence interval (CI) -5.30 to -1.92]. The NIE through labour force status and occupational skill level was -1.09 (95% CI -2.29 to 0.10) and -1.49 (95% CI -2.79 to -0.19) through both labour-force status/occupational skill level and income, corresponding to a percentage mediated of 41%. Among the employed, education had a much smaller effect on the MHI-5.
Improving employment opportunities could reduce nearly half of the adverse effects of low education on the mental health of young people.
受教育程度较低的年轻人的健康状况不如受教育程度较高的人。本文考察了就业和收入在多大程度上减轻了低教育对 20-35 岁人群心理健康的不利影响。
我们使用因果中介分析来估计低教育对心理健康的总因果效应（TCE），并通过两个中介物（就业情况（劳动力参与/职业技能水平）和收入）的顺序检验，将效应分解为自然直接效应（NDE）和自然间接效应（NIE）。使用澳大利亚家庭、收入和劳动力动态调查（HILDA）的三个波次（2012-14 年），在 20-35 岁的参与者中建立了低教育（未完成高中学业）、中介物和心理健康（心理健康量表-5 项版（MHI-5））之间的时间顺序。在那些就业的人当中，我们进行了进一步的分析，考察了工作特征作为低教育和心理健康之间关系的中介物的影响。
低教育对 MHI-5 的 TCE 为-3.61（95%置信区间（CI）-5.30 至-1.92）。通过劳动力状况和职业技能水平的 NIE 为-1.09（95% CI -2.29 至 0.10），通过劳动力状况/职业技能水平和收入的 NIE 为-1.49（95% CI -2.79 至-0.19），对应的中介百分比为 41%。在就业人群中，教育对 MHI-5 的影响要小得多。
改善就业机会可以减少近一半的低教育对年轻人心理健康的不利影响。
