title: Relationship between employment and mental health outcomes following Cardiac Rehabilitation: an observational analysis from the National Audit of Cardiac Rehabilitation.
abstract: BACKGROUND
  Employment status has been shown to impact mental health state and intervention outcomes, yet still to be studied in a Cardiac Rehabilitation (CR) population. This observational study investigated the relationship between employment status and mental health outcomes following Cardiac Rehabilitation (CR).
  
  
  METHODS
  All patients with an eligible cardiovascular incident entered into the National Audit of Cardiac Rehabilitation (NACR) 1 January 2013-31st December 2015. Logistic regression comparing the association between employment status and normal mental health categories.
  
  
  RESULTS
  A total of 24,242 CR patients with completed post CR assessments were included and had representative age and gender distribution (mean 65years, 73.2% male). At baseline the unemployed status had a lower proportion of patients in normal healthy categories than other groups (T-test and chi-squared p=<0.05). The regression analyses revealed no significant association between retired and employed groups and outcome. There was significant association between unemployed patients and all mental health outcomes except anxiety; all p values<0.05 and odds ratios between 0.525 and 0.772 showing less likelihood of achieving the normal healthy category.
  
  
  CONCLUSIONS
  This is the first UK study, using routinely collected data, to investigate in coronary heart disease patients the impact of employment status on outcomes. The findings were that when weighted for baseline differences, unemployed patients mostly had poorer outcomes. Teams involved in CR delivery should take particular care when interpreting mental health baseline measures when setting CR goals, especially in relation to unemployed patients, and efforts should be made in providing more patient tailored interventions.
authors.affiliation: University of York, Department of Health Sciences, York, UK. Electronic address: Alexander.harrison@york.ac.uk.
authors.forename: Alex S
authors.initials: AS
authors.lastname: Harrison
authors.affiliation: University of York, Department of Health Sciences, York, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Sumner
authors.affiliation: University of York, Department of Health Sciences, York, UK.
authors.forename: Dean
authors.initials: D
authors.lastname: McMillan
authors.affiliation: University of York, Department of Health Sciences, York, UK.
authors.forename: Patrick
authors.initials: P
authors.lastname: Doherty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000072038:Cardiac Rehabilitation / Q000639:trends*; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology*; D004651:Employment / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health / Q000639:trends*; D008875:Middle Aged; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
keywords: Coronary disease; Employment; Exercise; Rehabilitation; Secondary prevention