Paid employment and Common Mental Disorders (CMD) in the UK Dr. Gayan Perera, King’s College London (IoPPN) WHERL is an interdisciplinary consortium funded by the cross-research council Lifelong Health and Wellbeing (LLHW) programme under Extending Working Lives (ES/L002825/1)

Objective of WHerL How has the relationship between working until and beyond State Pension Age (SPA) and health and psychological health changed overtime.

Objective To investigate the association between employment status and Common Mental Disorder (CMD) in 50-64 year old residents in England compared with other age groups and its stability over time, taking advantage of three national mental health surveys carried out over a 14 year period.

Employment and Increase in older population Number of people of normal pension age and above who remain in work almost doubled to a total of 1.4 million between the years 1993 and 2011 in England. (ONS, 2012) Percentage of older People remaining in the workforce has also increased within this time period, from 7.6% in 1993 to 12.0% in 2011. (ONS, 2012)

Effect of paid work on health and well-being in later life Some studies suggest paid employment among older people is beneficial for health and well-being (Adam et al., 2007; Rohwedder and Willis, 2010; Behnke, 2012; Bonsang et al., 2012; Calvo et al., 2013) Some suggest that it is detrimental (Coe and Zamarro, 2011) and some that there is no significant or meaningful relationship (Coe and Lindeboom, 2008; Coe and Zamarro, 2011; Behnke, 2012; Calvo et al., 2013).

Method Data: British National Surveys of Psychiatric Morbidity of 1993, 2000 and 2007 Exposure: Paid employment status, Reason for not in employment Outcome: CMD the primary outcome – both ascertained identically in all three surveys (CMD from the revised Clinical Interview Schedule) Statistics: Multivariable logistic regression

Description of the sample by age, employment status and CMD (%) Males Females Characteristics 1993 (n=4133) 2000 (n=2769) 2007 (n=2355) 1993 (n=4132) 2000 (n=3047) 2007 (n=2697) Age 16- 24 558 (13.5) 319 (11.5) 269 (11.4) 630 (15.2) 347 (11.4) 296 (11.0) 25- 34 1090 (26.4) 616 (22.2) 411 (17.5) 1185 (28.7) 824 (27.0) 620 (23.0) 35- 44 927 (22.4) 673 (24.3) 609 (25.9) 997 (24.1) 865 (28.4) 800 (29.7) 45- 54 813 (19.7) 647 (23.4) 493 (20.9) 920 (22.3) 680 (22.3) 635 (23.5) 55- 64 745 (18.0) 524 (18.9) 573 (24.3) 400 (9.7) 331 (10.9) 346 (12.8) Not in paid employment (age specific % prevalence) 203 (36.4) 90 (28.2) 98 (36.4) 280 (44.4) 130 (37.5) 133 (44.9) 186 (17.1) 64 (10.4) 52 (12.7) 445 (37.6) 254 (30.8) 196 (31.6) 163 (17.6) 77 (11.4) 74 (12.2) 282 (28.3) 237 (27.4) 216 (27.0) 170 (20.9) 118 (18.2) 91 (18.5) 266 (28.9) 186 (27.4) 152 (23.9) 55- 64 (Males) 55-59 (Females) 374 (50.2) 216 (41.2) 217 (37.9) 192 (48.0) 145 (43.8) 135 (39.0) CMD present (score 12 or over) 466 (11.3) 402 (14.5) 331 (14.1) 816 (19.7) 641 (21) 618 (22.9)

Adjusted* odds ratios for association between non-employment and CMD in three survey years by age group Males Age 1993 (n=4133) 2000 (n=2769) 2007 (n=2355) 16- 24 2.01 (1.02, 3.98) 4.07 (1.15, 14.42) 4.06 (1.18, 14.00) 25- 34 1.05 (0.62, 1.76) 1.38 (0.59, 3.26) 6.07 (2.26, 16.32) 35- 44 2.39 (1.35, 4.22) 1.48 (0.71, 3.08) 3.04 (1.44, 6.45) 45- 54 2.19 (1.24, 3.86) 4.08 (2.15, 7.73) 2.37 (1.13, 4.98) 55- 64 1.58 (0.88, 2.85) 2.32 (1.21, 4.46) 1.44 (0.77, 2.69) *Adjusted for socio-demographic, socio-economic and health factors Females Age 1993 (n=4132) 2000 (n=3047) 2007 (n=2697) 16- 24 2.25 (1.39, 3.66) 1.48 (0.73, 3.02) 1.30 (0.57, 2.97) 25- 34 1.22 (0.87, 1.70) 1.16 (0.75, 1.80) 0.97 (0.59, 1.58) 35- 44 1.32 (0.91, 1.93) 1.34 (0.87, 2.05) 1.61 (1.01, 2.56) 45- 54 1.35 (0.92, 1.99) 1.88 (1.18, 2.98) 1.04 (0.63, 1.73) 55- 59 1.62 (0.81, 3.27) 1.15 (0.57, 2.30) 1.18 (0.61, 2.25)

Description of the sample by employment status and year of survey Male (n=8882) Female (n=9696) Year Employment status Model 2* Model 3** 25- 34 In paid employment Ref Short-term/ Long term-sick 9.54 (5.01, 18.17) 5.08 (2.53, 10.18) 8.27 (4.30, 15.90) 4.22 (2.11, 8.44) Unemployed 1.39 (0.92, 2.09) 1.16 (0.76, 1.79) 1.13 (0.90, 1.43) 1.04 (0.82, 1.32) 35- 44 9.34 (5.93, 14.70) 3.65 (2.20, 6.04) 6.81 (4.48, 10.36) 3.31 (2.10, 5.24) 1.82 (1.18, 2.82) 1.47 (0.93, 2.33) 1.15 (0.90, 1.48) 1.10 (0.85, 1.42) 45- 54 11.13 (7.55, 16.41) 5.19 (3.37, 7.98) 4.85 (3.45, 6.80) 2.37 (1.62, 3.46) 1.69 (1.04, 2.75) 1.39 (0.84, 2.31) 1.18 (0.88, 1.59) 1.11 (0.82, 1.51) 55+ 7.60 (5.22, 11.06) 3.60 (2.37, 5.46) 4.51 (2.81, 7.26) 1.79 (1.05, 3.06) 2.12 (1.21, 3.75) 1.92 (1.07, 3.46) 1.68 (1.09, 2.58) 1.51 (0.95, 2.38) *adjusted for socio-demographic and socio-economic factors **adjusted for socio-demographic, socio-economic factors and health factors

Odds ratios of ‘non-employment’ association with sub-components of CMD in the combined survey

Summary of findings Considering gender, the associations are generally stronger and more consistent in men than women. Considering age, the associations in men are generally strongest and most consistent in the 16-24 and 35+ age groups; health adjustments tend to attenuate these in the oldest group. The same is broadly true in women, although primarily in the 45-54 age group. Considering survey year, in men there is a marked strengthening of association from 1993 to 2007 in the 25-44 groups, whereas associations are strongest in the 2000 survey for the 45+ groups.

Summary of findings Associations between non-employment and CMD are much stronger for non-employment due to sickness. ‘Unemployment’ is associated with CMD in men aged 35+ after socio-demographic adjustments, but mostly confounded by health. The associations between health-related non-employment and CMD appears to decline in strength with increased age in women, but there are no obvious age trends in men.

Summary of findings Non-employment in the youngest age group is most strongly associated with cognitive complaints, panic, depressive ideas, anxiety, depression and sleep difficulties. Of these, depressive ideas, sleep difficulties and cognitive complaints remain strong in the oldest age group, joined by somatic complaints and worries about physical health Associations in the middle of the range are predominantly with anxiety and depression subscales.

www.wherl.ac.uk Thank you Authors: Gayan Perera1, Giorgio Di Gessa2, Laurie M. Corna2, Karen Glaser2, Robert Stewart1 1Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom 2Institute of Gerontology, Department of Social Science, Health & Medicine, King’s College London, London, United Kingdom www.wherl.ac.uk