Abstract
BackgroundThe 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. MethodsWe 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. ResultsA 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]). ConclusionsMoving 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.
Highlights
People living on lower incomes, those living below the poverty line, are more likely to have poor mental health and wellbeing (Kessler et al, 1994; Marmot, 2005; Ngui et al, 2010; Subramanian & Kawachi, 2006)
The mean value of our continuous General Health Questionnaire (GHQ)-36 measure across the sample was 11.3 (SD 5.6), and the prevalence of likely common mental disorder across all observations was 19.5% using a cut-off of GHQ ≥4 and 23.9% using a cut-off of GHQ ≥3
While income changes alone might not be as important as one might expect for mental health, their effects appear be intertwined with changes in poverty and employment status
Summary
People living on lower incomes, those living below the poverty line, are more likely to have poor mental health and wellbeing (Kessler et al, 1994; Marmot, 2005; Ngui et al, 2010; Subramanian & Kawachi, 2006). There is evidence that there may be a specific threshold effect on mental health and wellbeing of moving above or below a key level of absolute income such as the poverty line (Dang et al, 2019; McCarthy et al, 2018; Wickham et al, 2017). This has typically been studied as a separate binary exposure, rather than alongside consideration of income changes on a continuous scale. As the COVID-19 pandemic recedes, mini mising unemployment as well as poverty is crucial for population mental health
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