Depression Leads to Unemployment and Income Loss

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Depression Leads to Unemployment and Income Loss

Of participants with significant depressive symptoms at baseline, 33% reported unemployment in the subsequent 5 years, compared with 21% of those without symptoms.

Although cross-sectional studies suggest that depression may lead to low income and unemployment, investigators have not studied this potential link prospectively. In a 4-city, prospective, cohort study, researchers examined employment and income changes over 5 years among 2334 employed individuals (baseline family income, >$25,000; age range, 18-30; 61% white) who completed the Center for Epidemiological Studies–Depression (CES-D) Scale in 1991 as part of a larger study of heart disease risks.

Of participants with significant depressive symptoms (CES-D score, $≥$ 16) at baseline, 33% reported subsequent unemployment, compared with 21% of those without symptoms; after adjustment for potentially confounding factors (e.g., education, history of unemployment, and marital status), participants with symptoms had an odds ratio for unemployment of 1.6. A decrease in annual income, to below $25,000 at 5 years, was reported by 17% of symptomatic participants and 7% of asymptomatic participants (adjusted OR, 1.9). When sex-segregated subgroups of whites and blacks were examined, only the effects on income among black men remained significant, probably due to small sample sizes in the other groups. Of participants with depressive symptoms at baseline, 42% still had symptoms 5 years later and were more likely than participants with remitted symptoms to have incomes under $25,000, but were not more likely to be unemployed.

Comment: This study documents an apparent causal effect of depression on unemployment and lowered income, although it is also likely that lowered income and job loss aggravated depression. Low productivity and absenteeism, which have documented associations with depression, are likely mediators of these effects of depression. The findings are also consistent with observed improvements in productivity after successful depression treatment and argue for including income and employment effects among the benefits of identifying and treating depression in the workforce.

— Peter Roy-Byrne, MD

Published in Journal Watch Psychiatry January 23, 2003