Course of major depressive disorder and labor market outcome disruption

Abstract

Background: Major depressive disorder (MDD) has been found to be negatively associated with labor market outcomes. However, MDD has many different courses that are chronic or persistent, relapsing and remitting, or limited to a single lifetime episode. Such heterogeneity has been ignored in most past analyses.

Aims of the study: We examine the impact of heterogeneity in course of MDD on labor market outcomes.

Methods: Wave I (2001-2002) respondents of the National Epidemiological Survey on Alcohol and Related Conditions - a nationally representative panel survey - were interviewed on average 3 years later (2004-2005). We categorized changes in MDD before and after wave I and before wave II into six courses: incident, recent remission, persistent remission, relapse, persistent depression, and no history of MDD. Odds ratios (ORs) and marginal effects of MDD transitions in multivariable multinomial regressions of labor market outcomes (being out of the labor force, being unemployed, working part-time, and working full-time -- the reference outcome) are reported.

Results: Men and women who exhibited persistent remission (2 to 3 years) were equally likely to be in the labor force, employed, and working full-time, compared to those with no history of MDD (reference group). For men, recently remitted MDD (less than 1 year), compared to the reference group, increased the likelihood of being unemployed (3.2% higher probability of being unemployed conditional on being in the labor force; OR = 1.97, 95% confidence interval [CI] = 1.13--3.44) and working part-time (5.8% higher probability of working part-time conditional on being employed; OR = 1.75, 95% CI = 1.10-2.80). For women, no statistically significant effect for recent remission was found. The negative effects of incident onset, relapse, and persistence of MDD were found on some labor market outcomes for men and, to a lesser extent, for women.

Discussion: Clinical treatment for depression should be coordinated and/or integrated with work-related interventions that help individuals who are recovering from depression to maintain their jobs. Such coordination will add to the value of clinical treatment for depression.

Implications for health policies: The impact of MDD on labor market outcomes varies by course of illness. Past studies may have underestimated lost earnings due to mental illness because they did not distinguish between recent and persistent remission and thus did not account for lost earnings due to recent remission.

Implications for further research: Further research is needed to understand why there are differential impacts for men and women and to make causal inferences on the relationships between MDD and labor market outcomes.

Figure 1

Transition in Major Depressive Disorders between Wave I and Wave II of NESARC Note. NESARC = National Epidemiologic Survey on Alcohol and Related Conditions. Period 1 = life time to 12 months before wave I interview. Period 2 = past 12 months at wave I interview. Period 3 = between wave I interview and 12 months before wave II interview. Period 4 = past 12 months at wave II interview. Yes = diagnosed with major depression; and No = no depression.