The positive association between employment and self-reported mental health in the USA: a robust application of marginalized zero-inflated negative binomial regression (MZINB)

Abstract

Background Few studies have assessed the impact of employment on mental health among chronically ill patients. This study investigated the association between employment and self-reported mental unhealthy days among US adults. Methods For this cross-sectional cohort study, we pooled 2011–2017 Behavioral Risk Factor Surveillance System (BRFSS) survey data. We examined the association between employment and mental health in nine self-reported chronic conditions using marginalized zero-inflated negative binomial regression (MZINB). All analyses were conducted using SAS statistical software 9.4. Results Respondents (weighted n = 245 319 917) were mostly white (77.16%), aged 18–64 (78.31%) and employed (57.08%). Approximately 10% of respondents reported one chronic condition. Expected relative risk of mental unhealthy days was highest for employed respondents living with arthritis (RR = 1.70, 95% CI = [1.66, 1.74]), COPD (RR = 1.45, 95% CI = [1.41, 1.49]) and stroke (RR = 1.31, 95% CI = [1.25, 1.36]) compared to unemployed respondents. Employed males had 25% lower risk of self-reported mental unhealthy days compared to females. Conclusions Results show the interactive effects of employment on self-reported mental health. Employment may significantly impact on self-reported mental health among patients suffering from chronic conditions than those without chronic conditions.

Investigating the Associations Between Socioeconomic Factors and Unhealthy Days among Adults Using Zero-inflated Negative Binomial Regression

“…Overall, this study found that the following groups were more likely to report excessive zero mentally and physically unhealthy days: Men, older individuals, minorities, persons with higher educational attainment levels, persons who were employed, persons who were married or with a partner, and persons with one or zero chronic condition. This finding was aligned with a recent study utilizing these factors for MUD (Eric et al, 2020). For instance, persons who were with less conditions may not pay close attention to their health status and underestimate the MUD or PUD compared to individuals with two or more chronic conditions.…”

“…The current study utilized zero-inflated negative binomial modeling to investigate how state-level and individual-level socioeconomic factors are associated with American adults' self-reported 7 [16.5, 16.9] 1 (4. 4-5.3) 20.4 [20.2, 20.6] 2 (5.4-5.9) 25.8 [25.6, 26.1] 3 (6.0-6.4) 25.1 [24.9, 25.3] 4 (6.5-8.0) 11.9 [11.8, 12.1] Quintiles of Gini 0 (0.408-0.450) 22.4 [22.2, 22.6] 1 (0.452-0.458) 12.4 [12.3, 12.6] general health complaints, in terms of mentally, and physically unhealthy days (Eric et al, 2020), by controlling for individual-level covariates. First, results of the zero-inflated statistical models identified that individual-level demographic variables, such as sex and marital status, and individual-level socioeconomic variables, such as educational attainment, and median household income, were significantly associated with the likelihood of being in excessive zeros membership of MUD and PUD.…”

“…Accumulating evidence indicated relationships between socioeconomic factors at various levels and physical (mental) health outcomes (Dube et al, 2019; Jia et al, 2004). The current study utilized zero-inflated negative binomial modeling to investigate how state-level and individual-level socioeconomic factors are associated with American adults’ self-reported general health complaints, in terms of mentally, and physically unhealthy days (Eric et al, 2020), by controlling for individual-level covariates.…”

“…In contrast, the zero-inflated part should be used to identify factors that may underlie the presence of excessive zeros in responses. It is common to identify different patterns of associations when researchers employ the zero-inflated models (Eric et al, 2020; Lee et al, 2016; Zhou et al, 2014).…”

Life’s Crucial 12: Updating and Enhancing the Life’s Essential 8 of Cardiovascular Health: A proposal from NHANES

“…Poor self-reported Psychological Health status predisposes to mental illness, the expected risk of psychologically unhealthy days increased over time, and participants with mental illness were more likely to have a stroke (35,55). In addition, participants with stroke were associated with an elevated risk of self-reported mentally unhealthy days (32). In contrast, acculturation poses a significant risk for stroke (37).…”