The spatially and temporally varying association between mental illness and substance use mortality and unemployment: A Bayesian analysis in the contiguous United States, 2001–2014

Abstract

This study examined the spatiotemporally varying association between mental illness and substance use (MISU) mortality and unemployment, which was rarely explored in previous studies. We employed a spatiotemporal Bayesian hierarchical model to examine how the association varies over space and time after controlling eight covariates on county-level socioeconomic status. MISU mortality rates in 3108 counties in the contiguous U.S. between 2001 and 2014, a period including two economic recessions, were analyzed. The results showed that the association between MISU mortality and unemployment was spatially and temporally varying. Three compelling patterns were found: (1) the persistent high association in the rural Appalachian; (2) the rising high association in the Midwest; and (3) nearly all counties showed a weaker association during the Great Recession period than before and after.We provided possible explanations for such patterns as regional contexts including the insufficiency of healthcare facilities and relative deprivation. Our study demonstrated that the association between MISU mortality and unemployment is spatiotemporally different across counties in the U.S., and the paradoxical “benefit” of the economic recession to the effect of unemployment rates on MISU mortality rates. The results also reiterate the need for locally-focused policies for mitigating the impact of unemployment on mortalities.