Am J Epidemiol. 2022 Jul 23;191(8):1459-1469. doi: 10.1093/aje/kwac077.
Poor mental health among the unemployed-the long-term unemployed in particular-is established, but these associations may be driven by confounding from unobserved, time-invariant characteristics such as past experiences and personality. Using longitudinal register data on 2,720,431 residents aged 30-60 years, we assessed how current unemployment and unemployment history predict visits to specialized care due to psychiatric conditions and self-harm in Finland in 2008-2018. We used linear ordinary-least-squares and fixed-effects models. Prior to adjusting for time-invariant characteristics, current unemployment was associated with poor mental health, and the risk increased with longer unemployment histories. Accounting for all time-invariant characteristics with the fixed-effects models, these associations attenuated by approximately 70%, yet current unemployment was still associated with a 0.51 (95% confidence interval: 0.48, 0.53) percentage-point increase in the probability of poor mental health among men and women. Longer unemployment histories increased the probability among men in their 30s but not among older men or among women. The results indicate that selection by stable characteristics may explain a major part of the worse mental health among the unemployed and especially the long-term unemployed. However, even when controlling for this selection, current unemployment remains associated with mental health.
失业人群，尤其是长期失业人群的心理健康状况较差，这是既定事实，但这些关联可能是由未被观察到的、随时间不变的特征（如过去的经历和个性）造成的。本研究使用了芬兰 2008-2018 年 30-60 岁 2720431 名居民的纵向登记数据，评估了当前失业和失业史如何预测因精神疾病和自残到专科就诊的情况。我们使用了线性普通最小二乘法和固定效应模型。在调整随时间不变的特征之前，当前失业与心理健康状况较差有关，且风险随着失业时间的延长而增加。在固定效应模型中考虑所有随时间不变的特征后，这些关联大约减弱了 70%，但当前失业仍然与男性和女性心理健康状况较差的概率增加了 0.51（95%置信区间：0.48，0.53）个百分点有关。较长的失业史增加了 30 多岁男性的可能性，但不会增加老年男性或女性的可能性。研究结果表明，稳定特征的选择可能解释了失业人群，尤其是长期失业人群心理健康状况较差的主要原因。然而，即使在控制这种选择的情况下，当前的失业状况仍然与心理健康有关。
