Which of the following statements is true about the impact of unemployment on an individual

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Research Article | Open Access

Academic Editor: M. F. Allam, P. Bendtsen, E. A. Al-Faris

Received29 Aug 2011

Accepted18 Oct 2011

Published25 Dec 2011

The purpose of this study was to examine the impact of employment status and unemployment duration on perceived health, access to health care, and health risk behaviors. Data from Nevada's 2009 Behavioral Risk Factor Surveillance System [BRFSS] were analyzed. We compared participants who were unemployed [greater than and less than one year] to those who were employed and those who were voluntarily out of the labor force [OLF]. Unemployed participants had significantly worse perceived mental health profiles, were more likely to delay health care services due to cost, and were less likely to have access to health care than employed participants and OLF participants. OLF participants were not significantly different from employed participants. Contrary to previous findings, unemployed participants in this study were not more likely to binge drink, smoke, or be physically inactive. Findings from this study suggest that the impetus for unemployment, be it voluntary or involuntary, may significantly impact a person's mental health.

1. Introduction

In 2009, the United States faced its highest unemployment rates since 1982-1983 with rates reaching or exceeding ten percent in the last three months. From January to December 2009, national unemployment rates increased from 7.7% to 10.0% [1]. During this same time period unemployment rates in Nevada increased from 9.6% to 13.0%, which were the highest in the nation [1].

The relationship between unemployment and poor health has been well documented [2–6]. The unemployed tend to have higher levels of impaired mental health including depression, anxiety, and stress, as well as higher levels of mental health hospital admissions, chronic disease [cardiovascular disease, hypertension, and musculoskeletal disorders], and premature mortality [2, 5–12]. Some longitudinal studies have shown that higher levels of depression and unemployment are not just correlated, but that higher levels of depression are a result of unemployment [11, 13, 14]. Other prospective studies have found that poor mental health contributes to unemployment [15]. A study by Montgomery et al. [11] showed that subjects who had recently become unemployed had an adjusted relative risk of 2.10 for depression and anxiety compared to those who had not recently become unemployed. When participants with preexisting depression were excluded from the study, those who had greater than thirty-seven months of accumulated unemployment were two times more apt to be depressed or anxious than were the employed [RR = 2.04]. Additionally, unemployment is associated with unhealthy behaviors such as increased alcohol and tobacco consumption and decreased physical activity [9, 16, 17]. Studies have also demonstrated a positive correlation between employment and better health, improved self-confidence, self-esteem, and happiness [9, 18, 19].

Jahoda has argued that being employed satisfies a psychological need, a need which must be filled to maintain good mental health [20, 21]. Because of this psychological need which is fulfilled by employment, not only are the unemployed at risk for mental health problems, but also are people who are out of the labor force [OLF]. People who are OLF do not have a paid job and they are not seeking employment. The OLF category includes students, homemakers, and retirees [5].

Previous research has established employment status [employed or unemployed] as a determinant of health [2–6]. However, few studies have segmented the “unemployed” as [1] those who did not have work and were seeking employment—unemployed, and [2] those who did not have work and were not seeking employment—OLF. The purpose of this study was to compare perceived mental and physical health, access to health care, and risky health behaviors based on employment status [employed, unemployed, and OLF] and duration of unemployment [less than one year, greater than one year] by utilizing 2009 Behavioral Risk Factor Surveillance System [BRFSS] data. The research questions addressed by this study were as follows [1] Are general, mental, and physical health responses different based on employment status [employed, unemployed less than one year, unemployed longer than one year, or OLF]? [2] Do smoking, drinking, and physical inactivity rates differ by employment status? [3] Does access to health care or a delay in seeking health care services due to cost differ based on employment status? Based on Jahoda’s theory, we hypothesized that the employed would have better perceived mental and physical health than the OLF participants and the unemployed participants regardless of length of unemployment.

2. Methods

This study was a secondary analysis of the 2009 Nevada BRFSS survey data. Valuable mental health data is gathered through the administration of the BRFSS. The BRFSS is an annual, national, cross-sectional, random-digit dialing telephone survey that is conducted among noninstitutionalized adults 18 years of age or older in the United States [22]. The survey is a collaborative effort between the states and the Centers for Disease Control and Prevention. Survey questions gather information regarding demographics [age, gender, employment status, income level, education completed, etc.], perceived health status [general health, physical health, and mental health], and chronic disease status and health behaviors [smoking, drinking, physical activity, etc.]. The survey includes a core component with questions that are asked to all participants in every state. Core component questions include demographic information and current behaviors that impact health. Time to complete the core component questions is approximately fifteen minutes. Additionally, there are optional modules which the states may elect to fund if there is a special interest. In 2009, BRFSS participants from eight states were asked the optional mental illness questions in addition to the core component items. These states included Georgia, Hawaii, Mississippi, Missouri, Nevada, South Carolina, Vermont, and Wyoming [22]. We used Nevada for this study because the high rate of unemployment ensured that we had a sufficient sample size [𝑛] for the unemployment groups [1].

To provide an adequate sample size for smaller demographic areas in Nevada, disproportionate stratified sampling was employed. Smaller geographically defined populations in Nevada were oversampled to provide more precise estimates for those populations. Disproportionate sampling is preferred to proportionate sampling in states where the population is concentrated in a small geographical area as in Nevada. Data were collected regarding demographics, perceived general, physical, and mental health, chronic disease presence, and health behaviors. After the data were collected, they were then weighted for population attributes and nonresponse [22]. In 2009, 3,840 adult Nevadans completed the BRFSS survey. The response rate was 50.71%. Perceived health status was assessed by one question: would you say that in general your health is excellent, very good, good, fair, or poor? The question that measured perceived physical health was: for how many days during the past thirty days was your physical health not good? Two strategies were employed to assess perceived mental health: [1] a single question addressed the number of recent days of poor mental health: for how many days during the past thirty days was your mental health not good? and [2] A series of items targeting mental illness. The mental illness questions utilized a Likert scale with 1 [all the time] to 5 [none of the time] as anchors. These items measured the frequency of feelings of nervousness, hopelessness, restlessness/fidgety, depression, increased effort, and worthlessness. Lower scores represented poorer perceived health.

SAS 9.2 was used for the statistical analyses. Weighted descriptive statistics were performed to describe the characteristics of the population by gender, age, race, education, and income using PROC SURVEYFREQ. The Rao-Scott Chi-square test was utilized to determine statistically significant differences in proportions of employed, unemployed less than one year, unemployed longer than one year, and OLF with regard to descriptive statistics. Multiple logistic regression [MLR] was used to analyze dichotomous [yes/no] dependent variables using PROC SURVEYLOGISTIC. Employed participants served as the reference group. The MLR was then repeated while adjusting for age, income, education, and gender. An analysis of variance [ANOVA] and an analysis of covariance [ANCOVA] were conducted using PROC SURVEYREG to determine if the mean number of days of poor physical health or poor mental health or if mean mental health question scores varied between people who were employed, unemployed less than one year, unemployed longer than one year, and OLF. Age, income, gender, and education were used as covariates in the ANCOVA. A Tukey post hoc test was utilized when overall ANOVA/ANCOVA results were significant for group differences.

3. Results

Descriptive statistics of the sample are provided in Table 1 by employment status. Each variable showed significant differences between the groups. A higher proportion of employed and unemployed less than one year participants were male while a higher proportion of unemployed longer than one year and OLF participants were female [𝑃