Poverty, unemployment, and common mental disorders: population based cohort study

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Abstract
Objective: To determine whether poverty and unemployment increase the likelihood of or delay recovery from common mental disorders, and whether these associations could be explained by subjective financial strain. Design: Prospective cohort study. Setting: England, Wales, and Scotland. Subjects: 7726 adults aged 16-75 living in private households. Main outcome measures: Common mental disorders were assessed using the general health questionnaire, a self assessed measure of psychiatric morbidity. Results: Poverty and unemployment (odds ratio 1.86, 95% confidence interval 1.18 to 2.94) were associated with the maintenance but not onset of episodes of common mental disorders. Associations between poverty and employment and maintenance of common mental disorders, however, were much smaller than those of cross sectional studies. Financial strain at baseline was independently associated with both onset (1.57, 1.19 to 2.07) and maintenance (1.86, 1.36 to 2.53) even after adjusting for objective indices of standard of living. Conclusions: Poverty and unemployment increased the duration of episodes of common mental disorders but not the likelihood of their onset. Financial strain was a better predictor of future psychiatric morbidity than either of these more objective risk factors though the nature of this risk factor and its relation with poverty and unemployment remain unclear. The prevalence of the most common mental disorders, anxiety and depression, has been shown to be consistently associated with unemployment and measures of poverty, independent of occupational social class Unemployment and poverty were associated with the maintenance of episodes of most common mental disorders but not their onset Financial strain was a powerful independent predictor of both the onset and maintenance of episodes of common mental disorders, even after adjusting for more objective measures of standard of living Over 12 months poverty and financial strain, but not unemployment, were associated with significant increases in psychiatric morbidity; the effect of poverty increased with the level of baseline morbidity Further research is needed to better understand the nature of financial strain and its relation with unemployment and objective measures of standard of living