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Unemployment and subsequent depression: A mediation analysis using the parametric G-formula

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  • Bijlsma, Maarten J.
  • Tarkiainen, Lasse
  • Myrskylä, Mikko
  • Martikainen, Pekka

Abstract

The effects of unemployment on depression are difficult to establish because of confounding and limited understanding of the mechanisms at the population level. In particular, due to longitudinal interdependencies between exposures, mediators and outcomes, intermediate confounding is an obstacle for mediation analyses. Using longitudinal Finnish register data on socio-economic characteristics and medication purchases, we extracted individuals who entered the labor market between ages 16 and 25 in the period 1996 to 2001 and followed them until the year 2007 (n = 42,172). With the parametric G-formula we estimated the population-averaged effect on first antidepressant purchase of a simulated intervention which set all unemployed person-years to employed. In the data, 74% of person-years were employed and 8% unemployed, the rest belonging to studying or other status. In the intervention scenario, employment rose to 85% and the hazard of first antidepressant purchase decreased by 7.6%. Of this reduction 61% was mediated, operating primarily through changes in income and household status, while mediation through other health conditions was negligible. These effects were negligible for women and particularly prominent among less educated men. By taking complex interdependencies into account in a framework of observed repeated measures data, we found that eradicating unemployment raises income levels, promotes family formation, and thereby reduces antidepressant consumption at the population-level.

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  • Bijlsma, Maarten J. & Tarkiainen, Lasse & Myrskylä, Mikko & Martikainen, Pekka, 2017. "Unemployment and subsequent depression: A mediation analysis using the parametric G-formula," Social Science & Medicine, Elsevier, vol. 194(C), pages 142-150.
    • Handle: RePEc:eee:socmed:v:194:y:2017:i:c:p:142-150
    DOI: 10.1016/j.socscimed.2017.10.011
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    Cited by:

    1. Keyi Li & Paula Lorgelly & Sarah Jasim & Tiyi Morris & Manuel Gomes, 2023. "Does a working day keep the doctor away? A critical review of the impact of unemployment and job insecurity on health and social care utilisation," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 24(2), pages 179-186, March.
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    4. Vandoros, Sotiris & Avendano, Mauricio & Kawachi, Ichiro, 2019. "The association between economic uncertainty and suicide in the short-run," Social Science & Medicine, Elsevier, vol. 220(C), pages 403-410.
    5. Högnäs, Robin S. & Bijlsma, Maarten J. & Högnäs, Ulf & Blomqvist, Sandra & Westerlund, Hugo & Hanson, Linda Magnusson, 2022. "It's giving me the blues: A fixed-effects and g-formula approach to understanding job insecurity, sleep disturbances, and major depression," Social Science & Medicine, Elsevier, vol. 297(C).
    6. Alejandro Porras-Segovia & Eulalio Valmisa & Blanca Gutiérrez & Isabel Ruiz & Miguel Rodríguez-Barranco & Jorge Cervilla, 2018. "Prevalence and correlates of major depression in Granada, Spain: Results from the GranadΣp study," International Journal of Social Psychiatry, , vol. 64(5), pages 450-458, August.
    7. Bijlsma, Maarten J. & Wilson, Ben, 2020. "Modelling the socio-economic determinants of fertility: a mediation analysis using the parametric g-formula," LSE Research Online Documents on Economics 102414, London School of Economics and Political Science, LSE Library.

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