Economic insecurity is an emerging topic that is increasingly relevant to the labour markets of developed economies. This paper uses data from the British Household Panel Survey to assess the causal effect of various aspects of economic insecurity on mental health in the UK. The results support the idea that economic insecurity is an emerging socioeconomic determinant of mental health, although the size of the effect varies across measures of insecurity. In particular, perceived future risks are more damaging to mental health than realised volatility, insecurity is more damaging for men, and the negative effect of insecurity is constant throughout the income distribution. Importantly, these changes in mental health are experienced without future unemployment necessarily occurring.
Evidence of significant variation in the perceived utility of treatments across patients highlights the importance of taking individual patient preferences into account to improve AK treatment acceptability and adherence.
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Background
Addressing poverty through taxation or welfare policies is likely important for public mental health; however, few studies assess poverty’s effects using causal epidemiology. We estimated the effect of poverty on mental health.
Methods
We used data on working-age adults (25–64 years) from nine waves of the UK Household Longitudinal Survey (2009–19; n = 45 497/observations = 202 207 following multiple imputation). We defined poverty as a household equivalized income <60% median, and the outcome likely common mental disorder (CMD) as a General Health Questionnaire-12 score ≥4. We used double-robust marginal structural modelling with inverse probability of treatment weights to generate absolute and relative effects. Supplementary analyses separated transitions into/out of poverty, and stratified by gender, education, and age. We quantified potential impact through population attributable fractions (PAFs) with bootstrapped standard errors.
Results
Good balance of confounders was achieved between exposure groups, with 45 830 observations (22.65%) reporting poverty. The absolute effect of poverty on CMD prevalence was 2.15% [%-point change; 95% confidence interval (CI) 1.45, 2.84]; prevalence in those unexposed was 20.59% (95% CI 20.29%, 20.88%), and the odds ratio was 1.17 (95% CI 1.12, 1.24). There was a larger absolute effect for transitions into poverty [2.46% (95% CI 1.56, 3.36)] than transitions out of poverty [–1.49% (95% CI –2.46, –0.53)]. Effects were also slightly larger in women than men [2.34% (95% CI 1.41, 3.26) versus 1.73% (95% CI 0.72, 2.74)]. The PAF for moving into poverty was 6.34% (95% CI 4.23, 8.45).
Conclusions
PAFs derived from our causal estimates suggest moves into poverty account for just over 6% of the burden of CMD in the UK working-age population, with larger effects in women.
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