Long-term effects of mental disorders on employment in the National Comorbidity Survey ten-year follow-up
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Although significant negative associations of mental disorders with employment have been documented in epidemiological research, much of this research was based on cross-sectional samples and focused only on severe and persistent mental disorders. The present study examined the longitudinal associations of more common mental disorders with employment.
Data on the associations of common mental disorders with employment are presented here from 4501 respondents in the National Comorbidity Survey panel study, a two-wave community epidemiological survey of respondents aged 15–54 at baseline (1990–1992) who were re-interviewed in 2001–2003 and were employed, unemployed in the labor force or student at baseline. Lifetime mental disorders at baseline and disorders with onset after baseline were assessed with the Composite International Diagnostic Interview, a fully structured interview that assessed lifetime prevalence of internalizing fear disorders (panic, phobias), anxiety/misery disorders (major depression, generalized anxiety disorder, post-traumatic stress disorder), externalizing disorders (conduct disorder, alcohol and illicit drug abuse-dependence), and bipolar disorder.
Both baseline lifetime disorders and disorders with onsets after baseline were associated with significantly reduced odds of subsequent employment among respondents who were either employed or students at baseline. Population projections based on the assumption that these associations represented causal effects suggest that the mental disorders considered here were associated with 1.7–3.2 million adults being unemployed in the US population at follow-up.
Expanded access to treatment among current employees and students with mental disorders might lead to improved employment outcomes in these segments of the population.
KeywordsEmployment Impairment in functioning Disability Epidemiological survey
The secondary analysis of the NCS/NCS-2 data reported here was supported by National Institute of Mental Health (NIMH) (RM PI; grant number R01MH096826). The NCS data collection was also supported by NIMH (RCK PI; grant number R01MH46376), while NCS-2 data collection was supported by the National Institute on Drug Abuse (RCK PI; grant number R01DA012058). The views and opinions expressed in this report are those of the authors and should not be construed to represent the views of any of the sponsoring organizations, agencies, or US Government. A complete list of NCS and NCS-2 publications can be found at http://www.hcp.med.harvard.edu/ncs. The NCS-2 is carried out in conjunction with the World Health Organization World Mental Health (WMH) Survey Initiative. We thank the staff of the WMH Data Collection and Data Analysis Coordination Centres for assistance with instrumentation, fieldwork, and consultation on data analysis. These activities were supported by the NIMH (R.C.K., grant number R01MH070884), the John D. and Catherine T. MacArthur Foundation, the Pfizer Foundation, the US Public Health Service (R.C.K., grant numbers R13MH066849, R01MH069864, and R01DA016558), the Fogarty International Center (R.C.K., R03TW006481), the Pan American Health Organization, Eli Lilly and Company, Ortho-McNeil Pharmaceutical, Inc., GlaxoSmithKline, and Bristol-Myers Squibb. A complete list of WMH publications can be found at http://www.hcp.med.harvard.edu/wmh/.
Compliance with ethical standards
Conflict of interest
Dr. Mojtabai has received research funding from Bristol Myers-Squibb and Lundbeck pharmaceuticals. In the past 12 months, Dr. Kessler has served as a consultant for Hoffmann-La Roche, Inc. and the Johnson & Johnson Wellness and Prevention. Dr. Kessler has served on advisory boards for Mensante Corporation, Johnson & Johnson Services Inc. Lake Nona Life Project, and US Preventive Medicine. Dr. Kessler owns 25 % share in DataStat, Inc. Other authors declare no potential conflict of interest.
Original collection of NCS and NCS-2 data has been approved by the Institutional Review Board of Harvard University and performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. The analyses reported here have been approved by the Institutional Review Board of Johns Hopkins University, Bloomberg School of Public Health. All persons interviewed for NCS and NCS-2 surveys gave their informed consent prior to their inclusion in the study.
- 9.Ettner SL, Frank R, Kessler RC (1997) The impact of psychiatric disorders on labor market outcomes. National Bureau of Economic Research Cambridge, Mass, USAGoogle Scholar
- 16.Lagerveld SE, Bultmann U, Franche RL, van Dijk FJ, Vlasveld MC, van der Feltz-Cornelis CM, Bruinvels DJ, Huijs JJ, Blonk RW, van der Klink JJ, Nieuwenhuijsen K (2010) Factors associated with work participation and work functioning in depressed workers: a systematic review. J Occup Rehabil 20(3):275–292PubMedCentralCrossRefPubMedGoogle Scholar
- 20.Wang PS, Simon GE, Avorn J, Azocar F, Ludman EJ, McCulloch J, Petukhova MZ, Kessler RC (2007) Telephone screening, outreach, and care management for depressed workers and impact on clinical and work productivity outcomes: a randomized controlled trial. JAMA 298(12):1401–1411PubMedCentralCrossRefPubMedGoogle Scholar
- 30.Robins LN, Wing J, Wittchen HU, Helzer JE, Babor TF, Burke J, Farmer A, Jablenski A, Pickens R, Regier DA et al (1988) The Composite International Diagnostic Interview. An epidemiologic Instrument suitable for use in conjunction with different diagnostic systems and in different cultures. Arch Gen Psychiatry 45(12):1069–1077CrossRefPubMedGoogle Scholar
- 35.First MB, Spitzer RL, Gibbon M, Williams JBW (2002) Structured clinical interview for DSM-IV Axis I Disorders, research version, non-patient edition (SCID-I/NP). New York, Biometrics Research, New York State Psychiatric InstituteGoogle Scholar
- 37.Haro JM, Arbabzadeh-Bouchez S, Brugha TS, de Girolamo G, Guyer ME, Jin R, Lepine JP, Mazzi F, Reneses B, Vilagut G, Sampson NA, Kessler RC (2006) Concordance of the Composite International Diagnostic Interview Version 3.0 (CIDI 3.0) with standardized clinical assessments in the WHO World Mental Health surveys. Int J Methods Psychiatr Res 15(4):167–180Google Scholar
- 39.Howden LM, Meyer JA (2011) Age and sex composition. 2010 Census Briefs. United States Census Bureau. http://www.census.gov/prod/cen2010/briefs/c2010br-03.pdf
- 40.Wolter KM (2007) Introduction to variance estimation. Statistics for social and behavioral sciences, 2nd edn. Springer, New YorkGoogle Scholar
- 41.Research Triangle Institute (2004) SUDAAN: Professional software for survey data analysis, 9.0. Research Triangle Institute, Research Triangle Park, NCGoogle Scholar
- 51.US Bureau of Labor Statistics (2015) Labor force statistics from the current population survey. US Bureau of Labor Statistics. http://data.bls.gov/pdq/SurveyOutputServlet. Accessed 23 May 2015
- 53.US Bureau of Labor Statistics (2015) Local area unemployment statistics. http://www.bls.gov/lau/#tables. Accessed 23 May 2015
- 54.Kessler RC, Heeringa S, Lakoma MD, Petukhova M, Rupp AE, Schoenbaum M, Wang PS, Zaslavsky AM (2008) Individual and societal effects of mental disorders on earnings in the United States: results from the national comorbidity survey replication. Am J Psychiatry 165(6):703–711PubMedCentralCrossRefPubMedGoogle Scholar
- 55.Levinson D, Lakoma MD, Petukhova M, Schoenbaum M, Zaslavsky AM, Angermeyer M, Borges G, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Haro JM, Hu C, Karam AN, Kawakami N, Lee S, Lepine JP, Browne MO, Okoliyski M, Posada-Villa J, Sagar R, Viana MC, Williams DR, Kessler RC (2010) Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys. Br J Psychiatry 197(2):114–121PubMedCentralCrossRefPubMedGoogle Scholar