Unemployment pre-dates symptoms of depression and anxiety resulting in medical consultation in young men.
BACKGROUND
There is evidence to support a link between unemployment and lower levels of psychological well-being, but debate continues as to whether unemployment results in psychological morbidity, or whether the association is due to those who are more vulnerable to mental illness becoming unemployed. Here we assess the effect of recent and accumulated unemployment in young men on the risk of developing depression and anxiety leading to medical consultation. Adjustment was made for a measure of pre-existing tendency to depression, behavioural maladjustment, social class, qualifications and region of residence.


METHODS
Some 3241 men from the National Child Development Study (the 1958 British birth cohort) with data from birth to age 33 years, collected at birth and ages 7, 11, 16, 23 and 33 years were used in these analyses. The outcome measure was onset age of anxiety or depression between ages 24 and 33 years, that resulted in consultation with a GP or a specialist. This was used in Cox proportional hazards models where two measures of unemployment were modelled as time varying covariates. Pre-existing tendency to depression was measured by the Malaise Inventory prior to the experience of unemployment at age 23 years. Two measures of unemployment were investigated: any unemployment in the year prior to onset (recent unemployment) and all accumulated unemployment prior to onset (divided into four categories: 0, 1-12, 13-36 and 37+ months of unemployment).


RESULTS
After adjustment for potential confounding factors including pre-existing tendency to depression, the relative risk (RR) for developing symptoms resulting in consultation was 2.10 (95% CI: 1.21-3.63), when those who were unemployed in the year prior to onset were compared with those who were not. Accumulated unemployment was not statistically significantly related to onset of symptoms in all men after adjustment for the potential confounding factors: an RR of 1.63 (95% CI: 0.95-2.79) for men with 37+ months of accumulated unemployment when compared with none. However, exclusion of men with a pre-existing tendency to depression indicated by the Malaise Inventory score, increased the RR to 2.30 (95% CI: 1.44-3.65) for recent unemployment and 2.04 (95% CI: 1.17-3.54) for 37+ months of accumulated unemployment when compared with none.


CONCLUSIONS
Unemployment is a risk factor for psychological symptoms of depression requiring medical attention, even in those men without previous psychological vulnerability.
Montgomery
S M
SM
University Department of Medicine, Royal Free Hospital School of Medicine, University of London, UK.
Cook
D G
DG
Bartley
M J
MJ
Wadsworth
M E
ME
D000328:Adult; D001007:Anxiety / Q000453:epidemiology* / Q000523:psychology; D003863:Depression / Q000453:epidemiology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D016016:Proportional Hazards Models; D012306:Risk; D014478:Unemployment / Q000523:psychology*; D006113:United Kingdom / Q000453:epidemiology