How robust is the association between youth unemployment and later mental health? An analysis of longitudinal data from English schoolchildren.

BACKGROUND: Several studies show that youth unemployment is associated with worse mental health later in life. However, existing studies report results for only one model, or a few models, and use regression adjustment to support causal claims. We use two novel methods to address these gaps in the literature. METHODS: We use data from Next Steps, a cohort study of English schoolchildren who entered the labour market in the aftermath of the 2008-2009 global financial crisis, and measure mental health using the 12-item General Health Questionnaire (GHQ-12) at age 25. We use specification curve analysis and a negative control outcome design (a form of placebo test) to test whether associations between youth unemployment and later GHQ-12 scores are sensitive to model specification or are likely to be confounded by unobserved factors. RESULTS: We find that the association between unemployment and later GHQ-12 is qualitatively similar across 99.96% of the 120 000 models we run. Statistically significant associations with two placebo outcomes, height and patience, are not present when regression adjustments are made. CONCLUSIONS: There is clear evidence that youth unemployment is related to later mental health, and some evidence that this cannot be easily explained by unobserved confounding.

Recurrent back pain during working life and exit from paid employment: a 28-year follow-up of the Whitehall II Study.

OBJECTIVES: To examine the impact of recurrent, as compared with single, reports of back pain on exit from paid employment over decades of follow-up. METHODS: The study sample was from the British Whitehall II Study cohort (n=8665, 69% men, aged 35-55 at baseline), who had provided information about their reports of back pain between 1985 and 1994. Data about exit from paid employment (health-related and non-health related exit, unemployment and other exit) were collected between 1995 and 2013. Repeated measures logistic regression models were fitted to examine the associations, and adjust for covariates. RESULTS: Recurrent pain was reported by 18% of participants, while 26% reported pain on an occasion and 56% did not report pain. Report of back pain on an occasion was not associated with health-related job exit, whereas recurrent pain was associated with such an exit (OR 1.51; 95% CI 1.15 to 1.99), when compared with those who did not report pain. These associations were somewhat stronger among middle-grade and lower-grade employees, while these associations were not seen among higher-grade employees. Differences in associations by age and psychosocial working conditions were small. CONCLUSIONS: These results highlight the need for early detection of recurrent back pain to prevent exit out of paid employment for health reasons. As the risk varies by occupational grade, this emphasises the importance of identification of high-risk groups and finding ways to address their modifiable risk factors.

Short- and long-term effects of major organisational change on minor psychiatric disorder and self-rated health: results from the Whitehall II study.

OBJECTIVE: To investigate short- and long-term effects of major organisational change on minor psychiatric disorder and self-rated health for women and men in different employment grades. METHODS: Minor psychiatric disorder and self-rated health among 6710 British civil servants (1993 women and 4717 men) in three employment grades from the Whitehall II study were examined from 1985 to 1988 under stable employment conditions. The short-term effects of organisational change were investigated in 1991-1993 after a time of major restructuring aiming at increasing the influence of market forces in the civil service and the long-term effects were investigated in 1997-1999. RESULTS: Those who had experienced organisational change and those who anticipated organisational change reported more negative short-term health effects (minor psychiatric disorder and poor self-rated health) compared with those who reported no change. No major differences were found depending on employment grade or gender. The negative health effects had diminished during 1997-1999 for those who reported that a major change had happened before 1991-1993. Those who anticipated an organisational change in 1991-1993 still reported more ill-health in 1997-1999 (both minor psychiatric disorder and self-reported health) than those in the comparison group. CONCLUSIONS: The results indicate that organisational change affects employees' health negatively in the short term but also that it is possible to recover from such negative effects. As it was not possible to discern any definite difference between the gender and grades, the results point at the importance of working proactively to implement organisational change for women and men at all levels.

Variations in associations of health risk behaviors among ethnic minority early adolescents.

PURPOSE: To investigate patterns of vulnerability and protection factors associated with risk behaviors and the co-occurrence of risk behaviors in minority ethnicity early adolescents. METHODS: Analysis of data from the Research with East London Adolescents Community Health Survey (RELACHS), a school-based study of a representative sample of 2789 adolescents age 11-14 in 2001 (sample 73% non-Caucasian, 21% born outside the United Kingdom). Questionnaire data were obtained on sociodemographic variables, ethnicity, smoking, drinking, drug use, psychological well-being, physical health, and social support from family and peers. Models of associations for each behavior and co-occurrence of risk behaviors (defined as engaging in > or = 2 behaviors) were developed by hierarchical stepwise logistic regression. RESULTS: Two hundred ninety-two (10.9%) reported 1 risk behavior, 84 (3.1%) reported 2, and 25 (0.9%) reported 3 behaviors. In multivariate models, psychological morbidity was associated with higher risk of all behaviors and co-occurrence, while higher family support was associated with lower risk in all models. Non-Caucasian ethnicity was associated with lower risk of regular smoking and co-occurrence but not drinking or drugs. Birth outside the United Kingdom was associated with lower risk for individual behaviors but not co-occurrence. Religion and religious observance were associated with lower risk of smoking and drinking but not drug use or co-occurrence. Peer connectedness was associated with drug use, but with increased risk. Socioeconomic status was associated only with smoking. CONCLUSIONS: Patterns of associations of personal, family, and environmental factors appear to differ between smoking, drinking, lifetime drug use, and the co-occurrence of these behaviors. Hypotheses regarding common factors related to health risk behaviors may be misleading in ethnic minorities and immigrants. Co-occurrence may represent a distinct behavioral domain of risk that is partly culturally determined.

Ethnicity, social deprivation and psychological distress in adolescents: school-based epidemiological study in east London.

BACKGROUND: In adults the prevalence of psychological distress varies in different ethnic groups, and this has been explained by differences in socio-economic status. Is this also the case in adolescents? AIMS: To examine whether ethnic differences in prevalence of psychological distress in adolescents are associated with social deprivation. METHOD: A cross-sectional questionnaire survey was used to assess 2790 male and female pupils, aged 11-14 years, from a representative sample of 28 east London secondary schools. RESULTS: Rates of psychological distress were similar to rates in UK national samples in boys and girls. Bangladeshi pupils, although highly socially disadvantaged, had a lower risk of psychological distress (OR=0.63, 95% CI 0.4-0.9). Non-UK White girls had higher rates of depressive symptoms (OR=1.54, 95% CI1.1-2.2). CONCLUSIONS: High rates of depressive symptoms in non-UK White girls may be related to recent migration. Low rates of psychological distress in Bangladeshi pupils in this sample relative to White pupils, despite socio-economic disadvantage, could be associated with cultural protective factors that require further investigation.