Social Psychiatry and Psychiatric Epidemiology

, Volume 50, Issue 11, pp 1657–1668 | Cite as

Long-term effects of mental disorders on employment in the National Comorbidity Survey ten-year follow-up

  • Ramin Mojtabai
  • Elizabeth A. Stuart
  • Irving Hwang
  • Ryoko Susukida
  • William W. Eaton
  • Nancy Sampson
  • Ronald C. Kessler
Original Paper



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.


Employment 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 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

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.

Ethical standards

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.


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Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Ramin Mojtabai
    • 1
  • Elizabeth A. Stuart
    • 1
  • Irving Hwang
    • 2
  • Ryoko Susukida
    • 1
  • William W. Eaton
    • 1
  • Nancy Sampson
    • 2
  • Ronald C. Kessler
    • 2
  1. 1.Department of Mental Health, Bloomberg School of Public HealthThe Johns Hopkins UniversityBaltimoreUSA
  2. 2.Department of Health Care PolicyHarvard Medical SchoolBostonUSA

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