Skip to main content

Mental disorders: employment and work productivity in Singapore



To examine the association between mental disorders and work disability in the adult resident population in Singapore.


Data are from the Singapore Mental Health Study, which was a household survey of a nationally representative sample. The main instrument used was the Composite International Diagnostic Interview (CIDI). Employment-related information was collected using the modified employment module of the CIDI.


A total of 6,429 respondents were included in the analysis, 71 % (n = 4,594) were employed, 24.5 % (n = 1,522) were economically inactive and 4.5 % (n = 313) were unemployed. Among the employed, 2.3 % had a 12-month prevalence of at least one mental disorder, while 5.3 % of the unemployed had at least one mental disorder. The average number of work loss days (absenteeism) per capita among those with a mental disorder was 0.5 per month that is equivalent to an annualized national projection of approximately 0.3 million productivity days. The average work-cutback days (presenteeism) were 0.4 days among this group. Of the mentally ill in the workforce, a high proportion (86.5 %) did not ever seek help for problems related to mental health.


Our findings provide information on the significant consequences of mental disorders on the workforce in terms of lost work productivity, which could pave the way for a more rational allocation of scarce resources.

This is a preview of subscription content, access via your institution.


  1. 1.

    Cook JA (2006) Employment barriers for persons with psychiatric disabilities: update of a report for the President’s Commission. Psychiatr Serv 57:1391–1405

    PubMed  Article  Google Scholar 

  2. 2.

    Lahelma E (1992) Unemployment and mental well-being: elaboration of the relationship. Int J Health Serv 22:261–274

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Scheid T (1993) An investigation of work and unemployment among psychiatric clients. Int J Health Serv 23:763–782

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Claussen B, Bjorndal A, Hjort P (1993) Health and re-employment in a two year follow up of long term unemployed. J Epidemiol Community Health 47:14–18

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Broadhead WE, Blazer DG, George LK, Kit Tse C (1990) Depression, disability days, and days lost from work in a prospective epidemiologic survey. JAMA 264:2524–2528

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Stansfeld S, Feeney A, Head J, Canner R, North F, Marmot M (1995) Sickness absence for psychiatric illness: the Whitehall II Study. Soc Sci Med 40:189–197

    PubMed  Article  CAS  Google Scholar 

  7. 7.

    Mathers CD, Schofield DJ (1998) The health consequences of unemployment: the evidence. Med J Aust 168:178–182

    PubMed  CAS  Google Scholar 

  8. 8.

    Morrell SL, Taylor RJ, Kerr CB (1998) Unemployment and young people’s health. Med J Aust 168:236–240

    PubMed  CAS  Google Scholar 

  9. 9.

    Jin RL, Shah CP, Svoboda TJ (1995) The impact of unemployment on health: a review of the evidence. CMAJ 153:525–540

    Google Scholar 

  10. 10.

    Hammarstrom A, Janlert U (1997) Nervous and depressive symptoms in a longitudinal study of youth unemployment—selection or exposure? J Adolesc 20:293–305

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Montgomery SM, Bartley MJ, Cook DG, Wadsworth MEJ (1996) Health and social precursors of unemployment in young men in Great Britain. J Epidemiol Community Health 50:415–422

    PubMed  Article  CAS  Google Scholar 

  12. 12.

    Conti DJ, Burton WN (1994) The economic impact of depression in a workplace. J Occup Med 36:983–988

    PubMed  CAS  Google Scholar 

  13. 13.

    Kouzis AC, Eaton WW (1994) Emotional disability days: prevalence and predictors. Am J Public Health 84:1304–1307

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Greenberg PE, Stiglin LE, Finkelstein SN, Berndt ER (1993) The economic burden of depression in 1990. J Clin Psychiatry 54:405–418

    PubMed  CAS  Google Scholar 

  15. 15.

    Lim D, Sanderson K, Andrews G (2000) Lost productivity among full-time workers with mental disorders. J Ment Health Policy Econ 3:139–146

    PubMed  Article  Google Scholar 

  16. 16.

    Sanderson K, Andrews G (2006) Common mental disorders in the workforce: recent findings from descriptive and social epidemiology. Can J Psychiatry 51:63–75

    PubMed  Google Scholar 

  17. 17.

    Zhang M, Rost K, Fortney J, Smith R (1999) A community study of depression treatment and employment. Psychiatr Serv 50:1209–1213

    PubMed  CAS  Google Scholar 

  18. 18.

    Kessler R, Frank G (1997) The impact of psychiatric disorders on work loss days. Psychol Med 27:861–873

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Dewa C, Lin E (2000) Chronic physical illness, psychiatric disorder and disability in the workplace. Soc Sci Med 51:41–50

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Laitinen-Krispijn S, Bijl RV (2000) Mental disorders and employee sickness absence: the NEMESIS study. Soc Psychiatry Psychiatr Epidemiol 35:71–77

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Alegria M, Jackson JS, Kessler RC, Takeuchi D (2003) National Comorbidity Survey Replication (NCS-R), 2001–2003. Inter-university Consortium for Political and Social Research, Ann Arbor

    Google Scholar 

  22. 22.

    Kessler RC, Berglund P, Chiu WT, Demler O, Heeringa S, Hiripi E et al (2004) The US National Comorbidity Survey Replication (NCS-R): design and field procedures. Int J Methods Psychiatr Res 13:69–92

    PubMed  Article  Google Scholar 

  23. 23.

    Sprangers MAG, de Regt EB, Andries F, van Agt HM, Bijl RV, de Boer JB et al (2000) Which chronic conditions are associated with better or poorer quality of life? J Clin Epidemiol 53:895–907

    PubMed  Article  CAS  Google Scholar 

  24. 24.

    Stewart A, Greenfield S, Hays RD, Well SK, Roger WH, Berry SD et al (1989) Functional status and well-being of patients with chronic conditions: results from the medical outcomes study. JAMA 262:907–913

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Hays RD, Wells KB, Sherbourne CD, Rogers W, Spritzer K (1995) Functioning and well-being outcomes of patients with depression compared with chronic general medical illnesses. Arch Gen Psychiatry 52:11–19

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Wilson RW, Drury TF (1984) Interpreting trends in illness and disability: health statistics and health status. Annu Rev Public Health 15:83–106

    Article  Google Scholar 

  27. 27.

    Subramaniam M, Vaingankar J, Heng D, Kwok KW, Lim YW, Yap M, Chong SA (2012) The Singapore Mental Health Study: an overview of the methodology. Int J Methods Psychiatr Res. doi:10.1002/mpr.1351

  28. 28.

    Kessler RC, Ustun TB (2004) The World Mental Health (WMH) Survey Initiative version of the World Health Organization (WHO) Composite International Diagnostic Interview (CIDI). Int J Methods Psychiatr Res 13:93–121

    PubMed  Article  Google Scholar 

  29. 29.

    Bartley M, Ferrie J (2001) Glossary: unemployment, job insecurity, and health. J Epidemiol Community Health 55:776–781

    PubMed  Article  CAS  Google Scholar 

  30. 30.

    Chong SA, Abdin E, Vaingankar JA, Heng D, Sherbourne C, Yap M, Lim YW, Wong HB, Ghosh-Dastidar B, Kwok KW, Subramaniam M (2012) A population-based survey of mental disorders in Singapore. Ann Acad Med Singap 41:49–66

    PubMed  Google Scholar 

  31. 31.

    de Graaf R, Tuithof M, van Dorsselaer S, Ten Have M (2012) Comparing the effects on work performance of mental and physical disorders. Soc Psychiatry Psychiatr Epidemiol [Epub ahead of print]

  32. 32.

    Schulze B, Angermeyer MC (2003) Subjective experiences of stigma. A focus group study of schizophrenic patients, their relatives and mental health professionals. Soc Sci Med 56:299–312

    PubMed  Article  Google Scholar 

  33. 33.

    Stuart H (2006) Mental illness and employment discrimination. Curr Opin Psychiatry 19:522–526

    PubMed  Article  Google Scholar 

  34. 34.

    See Me Scotland. See me so far: A Review of the First Four Years of the Scottish Anti-Stigma Campaign. Scottish Executive 2006. Accessed 25 May 2012

  35. 35.

    Wahl O (1999) Mental health consumers’ experience of stigma. Schizophr Bull 25:467–478

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Wahl O (1999) Telling is risky business: mental health consumers confront stigma. Rutgers University Press, New Brunswick

    Google Scholar 

  37. 37.

    Kessler RC, Greenberg P, Mickelson K, Meneades L, Wang P (2001) The effects of chronic medical conditions on work loss and work cutback. J Occup Environ Med 43:218–225

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    McKevitt C, Morgan M, Dundas R, Holland WW (1997) Sickness absence and ‘working through’ illness: a comparison of two professional groups. J Public Health Med 19:295–300

    PubMed  Article  CAS  Google Scholar 

  39. 39.

    Cook JA, Razzano L, Straiton DM, Ross Y (1994) Cultivation and maintenance of relationships with employers of persons with severe mental illness. Psychosoc Rehabil J 17:103–116

    Google Scholar 

  40. 40.

    Diksa E, Rogers ES (1996) Employer concerns about hiring persons with psychiatric disability: results of the Employer Attitude Questionnaire. Rehabil Couns Bull 40:31–44

    Google Scholar 

  41. 41.

    Manning C, White PD (1995) Attitudes of employers to the mentally ill. Psychiatr Bull 19:541–543

    Article  Google Scholar 

  42. 42.

    Coyne JC, Gotlib IH (1983) The role of cognition in depression: a critical appraisal. Psychol Bull 94:472–505

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Dooley D, Prause J, Ham-Rowbottom KA (2000) Underemployment and depression: longitudinal relationships. J Health Soc Behav 41:421–436

    PubMed  Article  CAS  Google Scholar 

  44. 44.

    Friedland DS, Price RH (2003) Underemployment: consequences for the health and well-being of workers. Am J Community Psychol 32:33–45

    PubMed  Article  Google Scholar 

  45. 45.

    Fresco DM, Coles ME, Heimberg RG, Liebowitz MR, Hami S, Stein MB et al (2000) The Liebowitz Social Anxiety Scale: a comparison of the psychometric properties of self-report and clinician-administered formats. Psychol Med 31:1025–1035

    Google Scholar 

  46. 46.

    Campbell J, Schreiber R, Temkin T (1989) The well-being project: mental health clients speak for themselves. California Department of Mental Health, Office of Prevention, Sacramento

    Google Scholar 

  47. 47.

    Rogers ES, Walsh D, Masotta L, Danley K, Smith K (1991) Massachusetts survey of client preferences for community support services. Final Report, Center for Psychiatric Rehabilitation, Boston University, Boston

  48. 48.

    Uttaro T, Mechanic D (1994) The NAMI consumer survey analysis of unmet needs. Hosp Community Psychiatry 45:372–374

    PubMed  CAS  Google Scholar 

  49. 49.

    Van Dongen CJ (1996) Quality of life and self-esteem in working and nonworking persons with mental illness. Community Ment Health J 32:535–548

    PubMed  Article  Google Scholar 

  50. 50.

    Drake RE, Becker DR, Bond GR (2003) Recent research on vocational rehabilitation for persons with severe mental illness. Curr Opin Psychiatry 16:451–455

    Google Scholar 

  51. 51.

    Van Der Doef M, Maes S (1999) The job demand–control (support) model and psychological well-being: a review of 20 years of empirical research. Work Stress 13:87–114

    Article  Google Scholar 

  52. 52.

    North FM, Syme SL, Feeney A, Shipley M, Marmot M (1996) Psychosocial work environment and sickness absence among British civil servants: the Whitehall II study. Am J Public Health 86:332–340

    PubMed  Article  CAS  Google Scholar 

  53. 53.

    Jenkins R (1994) Mental illness and work. In: Floyd M, Povall M, Watson G (eds) Mental health at work. Jessica Kingsley, London, pp 77–79

    Google Scholar 

Download references


This research was supported by funding from the Singapore Millennium Foundation and the Ministry of Health, Singapore.

Author information



Corresponding author

Correspondence to Siow Ann Chong.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Chong, S.A., Vaingankar, J.A., Abdin, E. et al. Mental disorders: employment and work productivity in Singapore. Soc Psychiatry Psychiatr Epidemiol 48, 117–123 (2013).

Download citation


  • Mental disorder
  • Employment
  • Absenteeism
  • Presenteeism
  • Productivity