Unemployment and Health – a Public Health Perspective: Model Project

Abstract

Weber et al. present the consequences of unemployment for adults and focus on the social causation hypothesis (1). According to this hypothesis, unemployment is a co-factor in the development of disease. In younger people, another aspect has to be taken into consideration (selection hypothesis): in unemployed people younger than 25, job searches through job centers may fail because psychiatric disorders may make integration into the labor market difficult or impossible. The city of Essen has a model project to evaluate the mental health of unemployed people under the age of 25. Referrals to the psychologist and the psychiatrist of the project team are undertaken by case managers in job centers. If a young adult appears conspicuous, he or she is informed about the project and asked to participate in the psychiatric assessment if he or she so desires. These project workers have their offices in the job center so that the job seeker does not have to undertake any extra journey. If a disorder is diagnosed that requires treatment the client receives help in finding a therapist or commencing inpatient treatment. About 80 young adults have participated in the program so far (55% female; average age 21.4 years, 45% without school graduation); in 95% a psychiatric diagnosis was made – such as depression, anxiety disorder, or personality disorders. Only 10% of participants were receiving treatment at the time. The severity of the psychiatric disorders is often so pronounced that integration into the labor market seems unlikely without treatment. A methodological problem is the project allocation. Case managers will refer youths that seem conspicuous to them. The sample is therefore selective. In future, it would be interesting to compare these data with a more representative sample of young adults under 25. Treatment options for this target group are in the planning stages. Support 25 is a cooperative project between the Department of Child and Adolescent Psychiatry and Psychotherapy and the Department of Psychiatry and Psychotherapy of the University Duisburg-Essen, the Essen Job Center, and Essen Health Services Office.