Unemployment and subsequent depression : A mediation analysis using the parametric G-formula

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Bijlsma , M J , Tarkiainen , L H , Myrskylä , M & Martikainen , P T 2017 , ' Unemployment and subsequent depression : A mediation analysis using the parametric G-formula ' , Social Science & Medicine , vol. 194 , pp. 142-150 . https://doi.org/10.1016/j.socscimed.2017.10.011

Title: Unemployment and subsequent depression : A mediation analysis using the parametric G-formula
Author: Bijlsma, Maarten J.; Tarkiainen, Lasse Hannes; Myrskylä, Mikko; Martikainen, Pekka Tapani
Contributor: University of Helsinki, Department of Social Research (2010-2017)
University of Helsinki, Department of Social Research (2010-2017)
University of Helsinki, Department of Social Research (2010-2017)
Date: 2017
Language: eng
Number of pages: 9
Belongs to series: Social Science & Medicine
ISSN: 0277-9536
URI: http://hdl.handle.net/10138/230990
Abstract: The effects of unemployment on depression are difficult to establish because of confounding and limited understanding of the mechanisms at the population level. In particular, due to longitudinal interdependencies between exposures, mediators and outcomes, intermediate confounding is an obstacle for mediation analyses. Using longitudinal Finnish register data on socio-economic characteristics and medication purchases, we extracted individuals who entered the labor market between ages 16 and 25 in the period 1996 to 2001 and followed them until the year 2007 (n = 42,172). With the parametric G-formula we estimated the population-averaged effect on first antidepressant purchase of a simulated intervention which set all unemployed person-years to employed. In the data, 74% of person-years were employed and 8% unemployed, the rest belonging to studying or other status. In the intervention scenario, employment rose to 85% and the hazard of first antidepressant purchase decreased by 7.6%. Of this reduction 61% was mediated, operating primarily through changes in income and household status, while mediation through other health conditions was negligible. These effects were negligible for women and particularly prominent among less educated men. By taking complex interdependencies into account in a framework of observed repeated measures data, we found that eradicating unemployment raises income levels, promotes family formation, and thereby reduces antidepressant consumption at the population-level.
Subject: 5142 Social policy
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