文章基本信息

标题：Psychological Well-Being During the Great Recession: Changes in Mental Health Care Utilization in an Occupational Cohort
本地全文：下载
作者：Sepideh Modrek ; Rita Hamad ; Mark R. Cullen 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2015
卷号：105
期号：2
页码：304-310
DOI：10.2105/AJPH.2014.302219
语种：English
出版社：American Public Health Association
摘要：Objectives. We examined the mental health effects of the Great Recession of 2008 to 2009 on workers who remained continuously employed and insured. Methods. We examined utilization trends for mental health services and medications during 2007 to 2012 among a panel of workers in the 25 largest plants, located in 15 states, of a US manufacturing firm. We used piecewise regression to compare trends from 2007 to 2010 in service and medication use before and after 2009, the year of mass layoffs at the firm and the peak of the recession. Our models accounted for changes in county-level unemployment rates and individual-level fixed effects. Results. Mental health inpatient and outpatient visits and the yearly supply of mental health–related medications increased among all workers after 2009. The magnitude of the increase in medication usage was higher for workers at plants with more layoffs. Conclusions. The negative effects of the recession on mental health extend to employed individuals, a group considered at lower risk of psychological distress. A vast literature documents a robust relationship between unemployment and a variety of mental health disorders. 1,2 Although studies show that mental health deteriorates because of job loss, 3,4 which increases during recessions, less evidence exists on the impacts of recession on the mental health of remaining workers. However, the impacts of recessions on mental health may extend beyond the direct effect of unemployment. 5,6 Increased job insecurity, 6–9 feelings of powerlessness, 10 increased workload, and changes in job scope—as well as anger or sympathy for laid-off coworkers—may affect mental health. It is difficult to study the mental health of workers during recessions because measuring changes in mental health requires sensitive measures and panel data. We previously examined changes in new diagnoses of depression for an employed population during the recent recession and found no significant association, but this may be attributable to the high specificity of our measure, which might not have been sensitive enough to capture subtle changes in how workers feel. 11 Although self-reported symptoms or depression scales are thought to be sensitive to small changes in mental health, surveys with these measures tend to be cross-sectional and therefore cannot account for workers’ previous mental health. 1 If remaining workers are selected on mental health, then cross-sectional estimates may underestimate the true effect of recessions on the mental health of remaining workers, similar to the well-known healthy worker bias. 12 To estimate changes in mental health, panel data are necessary to take into account workers’ previous mental health. As an alternative to self-reported depression scales, we exploited detailed claims data for a panel of continuously employed, continuously insured workers during 2007 to 2010 to examine changes in use of mental health services and medications during the recent recession. We explored the yearly number of mental health inpatient and outpatient visits before and during the recession, as well as the yearly supply of prescriptions filled for opiates, antidepressants, sleep aids, and anxiolytics. We examined these 4 drug classes because previous research suggests that job stress is related to the onset of generalized anxiety disorder and depression 13 and that sleep disorders and drug abuse are often precursors to depression. 14 In addition, we examined opiates because stress is known to relate to a wide variety of psychosomatic illnesses, including chronic pain. 15,16 We focused on discontinuous changes in the trend for these 4 medication classes because evidence shows an increasing trend in their use across developed countries. 17 We found descriptive evidence of selection into our panel on both physical and mental health, making the remaining continuously employed and insured cohort healthier. We used piecewise regression, a method used to compare trends in an outcome variable before and after a defined discontinuity, to examine changes in trends after 2009. We accounted for individual-level unobservable time-invariant characteristics (e.g., gender, race, underlying health) with fixed-effects regressions. We also accounted for area-level changes in the unemployment rate. We explored the extent to which heightened job insecurity, caused by local plant layoffs, may have led to an increase in mental health services and treatments. We also examined the medium-term patterns in the mental health outcomes for the subset of workers who remained employed and insured through 2012, to investigate whether any of the observed changes in mental health–related utilization were long lasting or dissipated with the improvement in the economy in 2011 to 2012.