Which is most important for mental health: Money, poverty, or paid work? A fixed-effects analysis of the UK Household Longitudinal Study

Abstract

Background The relative importance of income, poverty and unemployment status for mental health is unclear, and understanding this has implications for income and welfare policy design. We aimed to assess the association between changes in these exposures and mental health. Methods We measured effects of three transition exposures between waves of the UK Household Longitudinal Study from 2010/11–2019/20 (n=38,697, obs=173,859): income decreases/increases, moving in/out of poverty, and job losses/gains. The outcome was General Health Questionnaire (GHQ), which measures likelihood of common mental disorder (CMD) as a continuous (GHQ-36) and binary measure (score ≥4 = case). We used fixed-effects linear and linear probability models to adjust for time invariant and time-varying confounders. To investigate effect modification, we stratified analyses by age, sex and highest education. Results A 10% income decrease/increase was associated with a 0.02% increase (95% CI 0.00, 0.04) and 0.01% reduction (95% CI -0.03, 0.02) in likelihood of CMD respectively. Effect sizes were larger for moving into poverty (+1.8% [0.2, 3.5]), out of poverty (−1.8%, [-3.2, −0.3]), job loss (+15.8%, [13.6, 18.0]) and job gain (−11.4%, [-14.4, −8.4]). The effect of new poverty was greater for women (+2.3% [0.8, 3.9] versus +1.2% [-1.1, 3.5] for men) but the opposite was true for job loss (+17.8% [14.4, 21.2] for men versus +13.5% [9.8, 17.2] for women). There were no clear differences by age, but those with least education experienced the largest effects from poverty transitions, especially moving out of poverty (−2.9%, [-5.7, −0.0]). Conclusions Moving into unemployment was most strongly associated with CMD, with poverty also important but income effects generally much smaller. Men appear most sensitive to employment transitions, but poverty may have larger impacts on women and those with least education. As the COVID-19 pandemic recedes, minimising unemployment as well as poverty is crucial for population mental health.

Comparing population-level mental health of UK workers before and during the COVID-19 pandemic: a longitudinal study using Understanding Society

“…*Wave 9 response rate for households (ie, at least 1 member responding) was 84.7% and the response rate for individuals (for full interview) was 76.8%;22 wave 10/11 response rates are not published as it is a combined survey bridging the gap between the latest annually collected data; and response rates for the COVID-19 surveys for those that were interviewed fully or partially at wave 9 are 42.0% for April, 35.1% for May, 33.5% for June, 32.6% for July, 30.6% for September and 28.6% for November 20 23–25Usoc, Understanding Society.…”

“…The pandemic has, therefore, been a major shock for employment and work, but its health implications remain underinvestigated. Links between work and mental health are well established [17][18][19][20] and evidence shows the mental health impacts of the pandemic. 2 5 21 22 We hypothesise that impacts are likely to be differential across industries, social class and occupations, as well as by gender, UK country and infection levels, 23 due to differences in work-related factors such as job demands, job insecurity and the protective measures implemented at regional or national levels.…”

Exploring the Impact of the COVID-19 Pandemic on Male Mental Health Emergencies Attended by Ambulances During the First National “Lockdown” in the East Midlands of the United Kingdom

“…Compared with females, males experiencing mental health emergencies attended by ambulances during “lockdown” were more likely to live in the most deprived regions of the East Midlands, represented by IMD Decile 1. A recent longitudinal study conducted in the United Kingdom found that men’s mental health is more severely impacted by employment circumstances compared with women (Kromydas et al, 2021). Over the course of the COVID-19 pandemic, unemployment has affected males in low-income occupations, such as construction, to a greater degree than males in higher earning occupations (Allas et al, 2020), with an associated disproportionate rise in unemployment benefit claims by men in most deprived neighborhoods (Trust for London, 2021).…”

Characterizing Unusual Spatial Clusters of Male Mental Health Emergencies Occurring During the First National COVID-19 “Lockdown” in the East Midlands Region, UK: A Geospatial Analysis of Ambulance 999 Data

“…Thus, the escalation from manageable psychological distress to mental health emergency could occur rapidly in deprived areas as “triggers” related to the pandemic accelerate preexisting vulnerabilities. In the United Kingdom, job loss in particular has been reported to affect male mental health more considerably than female mental health ( Kromydas et al, 2021 ).…”