Health-related selection into employment among the unemployed

Abstract

Background Successful transitions from unemployment to employment are an important concern, yet little is known about health-related selection into employment. We assessed the association of various physical and psychiatric conditions with finding employment, and employment stability. Methods Using total population register data, we followed Finnish residents aged 30–60 with an unemployment spell during 2009–2018 (n = 814,085) for two years from the onset of unemployment. We predicted any, stable, and unstable employment by health status using Cox proportional hazards models. The data on specialized health care and prescription reimbursement were used to identify any alcohol-related conditions and poisonings, psychiatric conditions and self-harm, injuries, and physical conditions. We further separated physical conditions into cancer, diabetes, heart disease, and neurological conditions, and psychiatric conditions into depression, anxiety disorders and substance use disorders. Results The likelihood of any employment was lower among those who had any of the assessed health conditions. It was lowest among those with alcohol-related or psychiatric conditions with an age-adjusted hazard ratio of 0.45 (95% confidence interval 0.44, 0.46) among men and 0.39 (0.38, 0.41) among women for alcohol-related and 0.64 (0.63, 0.65) and 0.66 (0.65, 0.67) for psychiatric conditions, respectively. These results were not driven by differences in socioeconomic characteristics or comorbidities. All the included conditions were detrimental to both stable and unstable employment, however alcohol-related and psychiatric conditions were more harmful for stable than for unstable employment. Conclusions The prospects of the unemployed finding employment are reduced by poor health, particularly alcohol-related and psychiatric conditions. These two conditions may also lead to unstable career trajectories. The selection process contributes to the health differentials between employed and unemployed people. Unemployed people with health problems may therefore need additional support to improve their chances of employment.

Disruption and selection: the income gradient in mortality among natives and migrants in Sweden

“…Lower income can have negative consequences for health, 8–10 for example through a lack of material resources or increased stress, 11 and poor health can in turn shape the individual capacity to participate in the labour market. 12 Because of these reflexive and longitudinal life-course processes, the relationship between income and health has been described as bi-directional. 13–15 As a result, persons with lower incomes are more likely to be in poor health, and persons with higher incomes, conversely, are more likely to be in better health.…”

Values, Health and Well-Being of Young Europeans Not in Employment, Education or Training (NEET)

“…In the general population, the relationship between poor health and well-being and unemployment is explained by social selection to unemployment [ 6 , 7 , 8 ] or the social causation process [ 9 ]. In short, social selection means that unhealthy people fail to get jobs (selected out), and the social causation process highlights the detrimental effects of unemployment on health and well-being (see [ 10 ]), for example, through diminished resources.…”

“…Mental health vulnerability (specifically among girls), substance use-related disorders (specifically among boys) and depressive symptoms and suicidal thoughts in youth precede but are an integral part of NEETs’ lives [ 20 , 21 , 22 , 23 ]. In later life, these can be fatal for future employment and career prospects because alcohol-related and psychiatric conditions hinder most from finding employment [ 6 ]. On the other hand, intense smoking and bad eating habits are common among NEETs [ 21 , 24 , 25 ].…”

Psychiatric Morbidity, Utilization and Quality of Mental Health Care in Long-Term Unemployed People

“…The complex relationship between unemployment and health impairments has been widely studied, specifically regarding unemployment and mental illness. Research has shown bidirectional interactions, wherein the causation hypothesis assumes that unemployment leads to mental illness through psychosocial stressors and an increase in risk behaviors, and the selection hypothesis postulates that mental illness increases the risk of losing a job and remaining unemployed [ 1 , 2 , 3 , 4 , 5 ]. It has been shown that the unemployed have up to two times an elevated risk of suffering from mental illness compared to those employed [ 6 , 7 ].…”