Paid employment and Common Mental Disorders (CMD) in the UK 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 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 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 employment status and year of survey   1993 (n=2,385) 2000 (n=1,871) 2007 (n=1,771) Variable In paid Employment Not in paid Employment Number 1279 1169 1123 751 1111 668 CMD present 126 (9.9) 195 (16.7) 130 (11.6) 189 (25.2) 134 (12.1) 155 (23.2) Reason for non-employment Health-related non-employment 265 (22.7) 232 (30.9) 170 (25.4) Other reason 904 (77.3) 519 (69.1) 498 (74.6) Marital status Divorced/separated 158 (12.4) 156 (13.4) 223 (19.9) 167 (22.2) 169 (15.2) 124 (18.6) Married/cohabiting 929 (73.0) 766 (65.9) 756 (67.3) 434 (57.8) 795 (71.6) 414 (62.0) Single 83 (6.5) 101 (8.7) 85 (7.6) 55 (7.3) 79 (7.1) 61 (9.1) Widowed 102 (8.0) 140 (12.0) 59 (5.3) 95 (12.6) 68 (6.1) 69 (10.3)

Description of the sample by employment status and year of survey   1993 (n=2,385) 2000 (n=1,871) 2007 (n=1,771) Variable In paid Employment Not in paid Employment Highest qualification A-level or above 280 (21.9) 124 (10.6) 331 (29.5) 133 (17.7) 477 (43.1) 161 (24.3) GCSE/GCE/O-level/other 521 (40.7) 437 (37.4) 362 (32.2) 227 (30.2) 347 (31.3) 195 (29.4) No qualifications 478 (37.4) 608 (52.0) 430 (38.3) 391 (52.1) 283 (25.6) 307 (46.3) Social class by occupation Professional/managerial/clerical 658 (51.4) 539 (46.1) 695 (61.9) 396 (52.7) 709 (63.8) 375 (56.1) Skilled/partly skilled 558 (43.6) 541 (46.3) 381 (33.9) 293 (39.0) 344 (31.0) 242 (36.2) Unskilled 63 (4.9) 89 (7.6) 47 (4.2) 62 (8.3) 58 (5.2) 51 (7.6)

Description of the sample by employment status and year of survey   1993 (n=2,385) 2000 (n=1,871) 2007 (n=1,771) Variable paid Employment Non-paid Employment Housing tenure Owned with a mortgage 616 (48.2) 279 (23.9) 552 (49.2) 161 (21.5) 471 (42.6) 123 (18.4) Owned outright 417 (32.6) 518 (44.3) 434 (38.6) 369 (49.3) 484 (43.8) 335 (50.2) Private or other renter 82 (6.4) 49 (4.2) 44 (3.9) 31 (4.1) 67 (6.1) 35 (5.2) Social housing 164 (12.8) 323 (27.6) 93 (8.3) 187 (25.0) 83 (7.5) 174 (26.1) Serious debt in the last year 51 (4.0) 48 (4.1) 49 (4.4) 72 (9.6) 37 (3.3) 53 (7.9) Seen a family doctor 823 (64.3) 883 (75.5) 741 (66.0) 559 (74.4) 717 (64.5) 498 (74.6) Smoking status No smoker 315 (24.6) 362 (31.0) 246 (21.9) 219 (29.2) 217 (19.5) 167 (25.0) Ex-smoker 639 (50.0) 521 (44.6) 633 (56.4) 359 (47.8) 553 (49.8) 306 (45.8) Current smoker 325 (25.4) 286 (24.5) 244 (21.7) 173 (23.0) 341 (30.7) 195 (29.2) At-least one ADL impaired 191 (14.9) 427 (36.5) 157 (14.0) 330 (43.9) 327 (29.4) 351 (52.5)

Odds ratios of ‘reason for non-employment’ association with CMD adjusted for various factors for 3 surveys   1993 (n=2,385) 2000 (n=1,871) 2007 (n=1,771) Adjustments Reason for non-employment OR P value Model 1: Age, gender and marital status In paid employment Ref Health 6.27 (4.46- 8.83) <0.001 8.72 (6.25- 12.2) 7.28 (5.01- 10.6) Other 1.30 (0.96- 1.77) 0.09 1.25 (0.89- 1.77) 0.2 1.48 (1.05- 2.08) 0.02 Model 2: Model 1+ education, social class, housing tenure and serious debt 5.83 (4.06- 8.38) 7.01 (4.88- 10.1) 5.30 (3.49- 8.04) 1.30 (0.96- 1.78) 1.24 (0.86- 1.77) 0.25 1.29 (0.91- 1.82) 0.16 Model 3: Model 2+ smoking status, physical health consultation and ADL impairment 3.05 (2.05- 4.55) 3.56 (2.36- 5.36) 2.80 (1.81- 4.36) 1.16 (0.85- 1.60) 0.35 1.13 (0.79- 1.64) 0.49 1.09 (0.76- 1.58) 0.64

Summary of findings The prevalence of CMD was higher in people not in paid employment for health reasons but was not associated with non-employment for other reasons. Associations had been relatively stable in strength from 1993 to 2007.

Policy implications Government and employers should provide support for those are willing to work longer. Even during economic prosperous times (year 2000), association between non-employment and CMD is high.

www.wherl.ac.uk Thank you Paper submitted to Psychological Medicine. 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