Differential Employment Quality and Educational Inequities in Mental Health: A Causal Mediation Analysis

Abstract

Background: In the United States, inequities in mental distress between those more and less educated have widened over recent years. Employment quality, a multidimensional construct reflecting the relational and contractual features of employer-employee relationships, may mediate this inequity throughout adulthood, yet no study has examined the extent of this mediation in the United States, or how it varies across racialized and gendered populations. Methods: Using the information on working-age adults from the 2001 to 2019 Panel Study of Income Dynamics, we construct a composite measure of employment quality via principal component analysis. Using this measure and the parametric mediational g-formula, we then estimate randomized interventional analogs for natural direct and indirect effects of low baseline educational attainment (≤high school: no/yes) on the end-of-follow-up prevalence of moderate mental distress (Kessler-6 Score ≥5: no/yes) overall and within subgroups by race and gender. Results: We estimate that low educational attainment would result in a 5.3% greater absolute prevalence of moderate mental distress at the end of follow-up (randomized total effect: 5.3%, 95% CI = 2.2%, 8.4%), with approximately 32% of this effect mediated by differences in employment quality (indirect effect: 1.7%, 95% CI = 1.0%, 2.5%). The results of subgroup analyses across race and gender are consistent with the hypothesis of mediation by employment quality, though not when selecting on full employment (indirect effect: 0.6%, 95% CI = −1.0%, 2.6%). Conclusions:We estimate that approximately one-third of US educational inequities in mental distress may be mediated by differences in employment quality.

A study exploring the impact of unemployment on the psychological well‐being of youth

“…They are filled with feelings of lost opportunity and uncertainty about their future. The results of our study are consistent with the findings of earlier research, in which it was discovered that unemployment can cause mental health problems in people from all walks of life, regardless of their educational background; the relationship between unemployment and mental health is complex and bidirectional, with unemployment functioning as both a triggering factor for mental discomfort and a result of existing mental health difficulties (Blaikie et al, 2023).Our findings indicate that unemployment has an impact on mental health and is associated with a decline in the psychological well-being of youth. Similar to our findings previous research also indicated that unemployed population is estimated their mental health to be worse, it has serious effects on mental health for those who are unemployed (Raj, 2023).…”

Multidimensional employment precariousness mediates the association between low educational attainment and poor subjective well-being: results from a nationwide cross-sectional study in South Korea

“…Our findings are in line with previous studies that have explored the mediating role of work environments and in the education-health relationship ( 27 , 28 ). A recent study conducted in the US has demonstrated that the influence of educational achievement on mental health problems is partially mediated through multidimensional employment quality, which accounts for approximately 32% of the total effect ( 35 ). The estimated mediating role of MEP was approximately 48–64% in this study, implying that precarious employment may have a larger contribution to the disparity in well-being associated with educational attainment within the Korean context compared with other countries.…”

“…For instance, one Australian study has suggested that occupational factors, such as psychosocial job quality, insecure employment relationship, and income can mediate the association between educational attainment and mental health (34). Similarly, previous US studies have demonstrated that the psychosocial work environment or employment quality can act as a mediator in the education-mental health relationship (35,36). However, there have been no studies examining how occupational experiences and exposures mediate the relationship between education level and mental health in the context of Korea or the broader East Asian region.…”