Duke 2008 | ASHE | Equity and Efficiency in Health and Healthcare

Objective: To examine the associations between psychiatric disorders and labor market activities among U.S. adults.

Background: A number of studies have established a relationship between psychiatric disorders and labor market outcomes. However, despite the noted high prevalence of co-occurring psychiatric disorders, relatively little evidence exists on how the co-occurrence may be associated with labor market outcomes. This paper addresses this gap by examining the relationship among profiles of concurrent disorders and labor market outcomes.

Methods: The study uses data from a sample of men and women aged 18 to 64 in the National Epidemiologic Survey on Alcohol and Related Conditions for 2000/2001 (NESARC). In addition to labor market outcomes, the NESARC includes criteria used in the Diagnostic and Statistical Manual of Mental Disorders to diagnose psychiatric disorders. Following Johnson (2007), 10 clinically meaningful and mutually exclusive psychiatric disorder profiles are defined from four common categories: mood disorders, anxiety disorders, behavioral disorders and substance use disorders (SUD). We examine the relationship among these disorder profiles and each of three labor market outcomes: labor force participation, employment, and full time working status. Logistic regressions with survey design corrected standard errors and weights are used to estimate the associations in the U.S. population.

Results: We present results for men and women separately. For women, preliminary results suggest five general findings. First, mood disorders, either alone or combined with other disorders, are negatively associated with labor force participation and employment status. Second, anxiety disorders are associated negatively with all three outcomes. Third, SUD does not seem to have a consistent association with labor market outcomes; SUD only and SUD combined with anxiety increase labor force participation, whereas SUD combined with anxiety is associated with decreases in employment. Fourth, employment status is significantly associated with most of the 10 profiles, the only two exceptions being behavioral disorders combined with SUD and SUD alone. Fifth, full time working status is not statistically significantly associated with 9 out of the 10 profiles, the exception being anxiety alone. For men, three generalizations are apparent. First, most profiles with a mood disorder are negatively associated with labor market outcomes; this finding is similar to that for women. Second, anxiety disorders do not have a significant association, except for a limited number of specific instances in which they are combined with other disorders. Third, the associations between psychiatric profiles and labor force participation and working full time are stronger than any associations found for employment; this finding is contrary to that found for women. For both genders having three or more concurrent disorders has the largest negative effects on employment.

Conclusions: The co-occurrence of psychiatric disorders has a larger association with labor market activities than any association for a single category of disorders. However not all concurrent disorders are associated with labor market outcomes. Improving the mental health of the nation and strengthening the employee assistance programs may benefit employers