Unemployment and psychological distress among young adults in the Nordic countries: A review of the literature

This article reviews Nordic research, published from 1995 and onwards, on the relationship between unemployment and mental health among young adults. Cross‐sectional, longitudinal and time‐series studies are included. Cross‐sectional studies show that the unemployed experience more mental health problems than the non‐unemployed. Leaving unemployment is associated with increased well‐being. Economic problems, feelings of shame and poor social support increase the likelihood of psychological distress. The longitudinal studies show that unemployment increases the risk of psychological distress and attempted suicide, after initial mental health status and confounding factors are accounted for. The relationship remains significant when time‐invariant characteristics of the individuals are controlled for. The time‐series studies found no relationship between unemployment and suicide, but levels of psychological distress were found to vary with changes in the labour market. This relationship remained significant after excluding the non‐employed, indicating that unemployment trends have effects beyond those directly associated with unemployment.     

Suicide and mental health problems among Swedish youth in the wake of the 1990s recession

The purpose of this explorative study is to bring together a variety of Swedish data sources with indicators of youth mental health and living conditions in order to illuminate trends during the last decades, elucidate possible determinants of mental ill health and develop hypotheses to explain the observed trend patterns. The analyses in the study reveal some surprising inconsistencies with respect to the mental health trends among young people during the 1990s. Most striking is the pattern of increasing youth unemployment coinciding with almost inverse trends in the rates of suicide. The secular trends in fatal suicides during this period do not show any increase but some actual decrease in sub‐populations despite high sustained levels of unemployment. In contrast, survey data indicate that the general mental health of youth during this period appears to have deteriorated.     

Unemployment and mental health: evidence from research in the Nordic countries

In this article we examine research on effects of unemployment on mental health in Denmark, Finland, Norway and Sweden. We describe studies that use cross-sectional, longitudinal and time-series data, and we discuss studies that investigated the duration-dependence issue in exit rates out of unemployment. Not surprisingly, cross-sectional studies reveal that unemployed persons have worse mental health than do others. Most longitudinal studies suggest that unemployment is associated with deteriorating mental health, even though it is somewhat unclear how long such an effect persists. Most duration-dependence studies were done using Swedish data. It turns out that unemployment benefits and labour-market policies affect the pattern of exit rates out of unemployment.     

Socio‐Economic Factors and Mental Health of Young People in India and China: An Elusive Link with Globalization

Globalization and its related social, cultural, and economic changes have significant mental health outcomes for young people. However, mental health disorders among youth are seldom included in the range of problems linked to globalization. It is imperative that these multifaceted associations are considered in light of the substantial and increasing burden of disease caused by mental illness, particularly in Asian countries, which are comparatively young and in next few decades will be the major sources of the growth of world’s young population. The evidence reviewed in this study makes an argument that globalization has increased [relative] poverty and deprivation, social and income inequality, migration, occupational stress, educational competition, and educated unemployment in India and China. Simultaneously there is evidence which shows that these variables are causally linked with mental health of young people. Altogether, these phenomena are accompanied by higher rates of suicide among lower class, migrant, and student youth. This substantiates the proposition that globalization has significant consequences for the mental health of young people. Some interventions for debate and discussion are considered.     

Association Between Unemployment Duration and Depression in the SouthWest Region of Turkey: A Cross-Sectional Study

ABSTRACT

Unemployment has risen as an effect of globalization in the country of Turkey. To date, no studies have examined the association between the duration of unemployment and perceived mental health. Therefore, the aim of this study is to evaluate the association between the duration of unemployment and the incidenence of depression among citizens in the southwest region of Turkey. A questionnaire was developed and distributed to 908 unemployed individuals. The questionnaire gathered sociodemographic characteristics and employment-related circumstances. To measure mental health, a depression inventory was administered and group-wise t-tests and logistic regressions were conducted. The findings show that long-term unemployed persons had more episodes of depressive moods in the past 12 months when compared with the group of the short-term unemployed. In addition, depression levels were higher among the long-term unemployed compared with the short-term unemployed. It was estimated that the duration of unemployment and the measurement of depression had a positive correlation. Risk factors that increased depression in the short-term unemployed were gender (female), older age, and greater periods of unemployment. However, higher education, income, and having social insurance significantly decreased the risk of developing depression for both the short-term and the long-term unemployed. Future recommendations include supportive counseling to increase motivation levels and developing strategies to handle periods of unemployment.     

Welfare Generosity,Abortion Access,and Abortion Rates: A Comparison of State Policy Tools*

Objective. This article tests if welfare generosity is related to abortion rates, allowing effects to vary by program type and abortion policy context. Methods. Measuring welfare generosity with respect to cash assistance, family caps, Medicaid, child care and family leave policies, I estimate fixed effects models of abortion rates in 48 U.S. states over 1987–2000. Results. More expansive family leave laws are associated with lower abortion rates. In states that do not enforce any of three key abortion policies, increased Medicaid eligibility and child care spending predict higher abortion rates. For Medicaid, this relationship diminishes and reverses itself as states add abortion regulations. Conclusion. Welfare state expansions may help reduce abortion, but programs' effects are not unambiguously pro‐natalist. Estimated impacts of welfare generosity on abortion rates vary by program, and some with abortion policy context.     

Unemployment, Age, Gender and Regional Suicide in England and Wales 1974-90: A Harbinger of Increased Suicide for the 1990s?

Correspondence to Prof. Colin Pritchard, Department of Social Work Studies, University of Southampton, Highfield, Southampton SO9 SNH. Summary The Department of Health's Health of the Nation aims at a substantialreduction in suicide; this is a ‘vote of confidence’in the effectiveness of the community psychiatric and healthservices. However, it will be shown that a number of socioeconomicchanges have occurred which may lead to increased suicide; forexample British male suicide rose in the 1980s, significantlyassociated with unemployment. Though female suicide fell substantiallyover the period, across the regions suicide rates for both menand women were worse amongst the ‘work age’ bands,16–44 years, than the older groups. In respect to therelatively poorer rates amongst younger women, this may be linkedto unemployment and their unfulfilled job expectations. If thesuicide targets are not met, it is feared that the ‘failure’will laid at the door of the community and health services.     

Sleep among youths in foster care: Associations with potentially traumatic events,PTSD and mental health

Among maltreated youth in foster care, little is known about frequency of sleep problems and its association to potential traumatic events (PTEs) and mental health. Among youths in foster care, we examined: (1) sleep patterns, difficulties initiating and maintaining sleep (DIMS) and related functional impairment; (2) whether exposure to PTEs, symptoms of post‐traumatic stress disorder (PTSD) and general mental health problems are associated with DIMS and related functional impairment, controlling for age, gender and time in foster care; and (3) whether PTSD and general mental health problems mediate the association between PTEs and DIMS. Foster youths in Norway (n = 299) completed a survey on sleep behaviour, the Child and Adolescent Trauma Screen, and the Strengths and Difficulties Questionnaire. Overall, 53.2% reported DIMS. For 82.1%, these sleep problems had lasted 3 months plus. Increased PTEs, PTSD and general mental health problems were all associated with increased DIMS score. Increased rate of PTEs was associated with decreased sleep duration. PTSD and general mental health problems partially mediated the association between PTEs and DIMS. Youth in foster care are at high risk of sleep problems, related to traumatic experiences and mental health problems. Treatment of PTSD may improve sleep problems among maltreated youth.     

Unemployment, shame and ill health — an exploratory study

Unemployed young people in six Swedish municipalities were studied in respect of the degree of shaming elements experienced by them in their social environment and in respect of mental ill health. The nature of the investigation was exploratory. The study shows that experience of shaming elements in the environment owing to unemployment is relatively frequent. A larger proportion of the long-term unemployed and men account for more shaming elements than do the short-term unemployed and women. It seems as if the factor of shaming elements in the environment is important in order to understand the adverse health-related consequences of unemployment. A greater proportion of those who live in a more shaming environment show mental disorders, deteriorated health, changes in living habits, activities and social relations, than do those living in a less shaming environment. This report discusses possible explanations of the results in the light of existing moral concepts of work and unemployment, as well as of shaming attitudes towards the unemployed.     

CREATING ‘CHILD‐FRIENDLY’ COMMUNITIES: A STRATEGY TO RECLAIM CHILDREN FROM RISK

A review of the scope and characteristics of the problems facing Australian children and adolescents. Such issues as poor mental health, substance use and abuse, delinquency, violence, school drop‐out rates, youth unemployment and suicide are explained in terms of shortfalls in community endeavour to protect families from risk factors associated with structural and social change. A strategy to reduce vulnerability is proposed, which would involve mobilising government, independent and informal local community sectors to support parents and encourage healthy, pro‐social development. Sustaining the quality of social environments close to children and families requires a process of community capacity‐building, including a renewed emphasis on participation and democracy and better coordination between local service agencies.     

Macroeconomic and financing determinants of out of pocket payments in health care: Evidence from selected OECD countries

In this paper, we examine the impact of macroeconomic, as well public and private health insurance financing (PHI) factors on out of pocket (OOP) healthcare expenditures, by using fixed/random effects and dynamic panel data methodology to a dataset of 26 EU and OECD countries for a period lasting from 1995 to 2013. The existing empirical literature has focused on testing the hypothesis that several macroeconomic and health financing determinants have an effect on OOP healthcare expenditures. Nevertheless, the related articles have not well tested the hypothesis concerning the potential impact of PHI financing on OOP spending. We find that public and PHI financing have a significant countervailing effect on OOP spending. Moreover, we show that unemployment rate has a significant positive impact on OOP expenditures. Sensitivity tests with variation of specifications and samples show that our findings are robust. We argue that policy-makers should give serious consideration to PHI institution; our results indicate that there is an inverse effect on OOP spending. We suggest that our examined countries have to provide financial risk protection to their citizens against OOP payments, rather than only attending health budgetary retrenchments in order to adjust public finances.     

Economic distress and health: A fixed effects analysis of low‐income persons in Singapore

Using fixed effects regressions, this study examined the transactional effects of different types of economic status on the physical and mental health of low‐income persons in Singapore. Among the economic variables considered, unemployment and arrears had the most significant effects. This signals the physical and psychological distress of being out of work and possessing arrears while income is low. The insignificant effects of poor health on household earnings suggest possible earnings supplementation by other household members. The findings imply the fruitfulness of dually improving employment prospects and health, work activation that takes into consideration mental health effects, increasing affordability of health services in liberal welfare systems, improving mental bandwidth through reducing arrears accounts, and short lag time from application to receipt of assistance. These implications point to a larger question on health and welfare systems in an increasingly uncertain economic environment for households in poverty. Key Practitioner Message: ? Employment and health are inter‐related: employment assistance incorporating physical and mental health interventions and vice versa can be more effective than either alone; ? Compared with decreasing arrears amounts, reducing the number of arrears can more effectively relieve mental distress; ? Effects between economic distress and health materialise quickly; minimising the lag time between application and receipt of assistance will provide great relief.     

Delayed Hospital Discharge and Mental Health: The Policy Implications of Recent Research

In 2003, the Community Care (Delayed Discharges etc.) Act introduced charges for social services departments unable to discharge patients from hospital within agreed timescales. As details of this reimbursement policy have begun to emerge, it has become apparent that the new system may also be extended to mental health services. In response, this narrative review of the literature on delayed hospital discharges and mental health reports findings from 12 studies, which raise important and timely concerns about the feasibility of reimbursement. Although a significant number of people experience delayed discharges from acute psychiatric services, the task of defining delayed discharges is complex and subjective, dependent on the professional background and seniority of the person making the judgement. Reasons behind delayed discharges are also multi‐factorial in nature and cannot be attributed to social services departments alone.     

A racial comparison of Family Group Decision Making in the USA1

This study examined Family Group Decision Making (FGDM) among a nationally representative sample of African‐American and White children investigated for maltreatment in the US. While FGDM was developed for work with ethnic minority families, there is no research on how this is being carried out in the US, where African‐American children are overrepresented in child welfare services. The study views racial differences in child, caregiver and maltreatment characteristics related to FGDM; composition of FGDM meetings; service referrals and receipt; and service satisfaction. Data are from the National Survey of Child and Adolescent Well‐being (NSCAW), a study of 5501 children ages 0–14. Current analyses include African‐American and White children (n= 4129). Stratified, bivariate and multivariate regression analyses were used. Results showed that while race was not related FGDM receipt, different characteristics lead to FGDM among African‐American and White families. Surprisingly, caregivers report feeling no more involved in decision‐making in association with FGDM. FGDM is provided at low rates overall (10%) and less frequently among White caseworkers. Child access to mental health services increases in relation to FGDM. Implications are discussed.     

Racial Differences in Attitudes Toward Professional Mental Health Treatment: The Mediating Effect of Stigma

Stigma associated with mental illness continues to be a pervasive barrier to mental health treatment, leading to negative attitudes about treatment and deterring appropriate care seeking. Empirical research suggests that the stigma of mental illness may exert an adverse influence on attitudes toward mental health treatment and service utilization patterns by individuals with a mental illness, particularly African Americans. However, little research has examined the impact of stigma on racial differences in attitudes toward seeking mental health treatment. This study examined the hypothesis that stigma partially mediates the relationship between race and attitudes towards mental health treatment in a community-based sample of 101 African American and White older adults. Multiple regression analyses and classic path analysis was utilized to test the partial mediation model. Controlling for socio-demographic factors, African American older adults were more likely to have negative attitudes toward mental health treatment, and they also reported more public and internalized stigma than their White counterparts. As hypothesized, the relationship between race and attitudes toward mental health treatment was partially mediated by internalized stigma, suggesting that internalized stigma may cause older adults to develop negative attitudes about mental health treatment. The partial mediation model was not significant for public stigma, however. Implications for social work research and practice are discussed.     

Physical and mental health changes in aging foster parents: Do child behavioural problems hasten declines?

This study examined foster parent physical and mental health over time. It was hypothesized that increased severity and frequency of child behavioural problems, whether externalizing or internalizing, would be associated with poorer health over time, especially for foster parents ≥60 years of age. Data from the baseline and Wave 2 interview of the 2010 National Survey of Child and Adolescent Well‐Being were used. The final analytic sample included kin and nonkin foster parents who had custody of a foster child for both waves of data collection (n = 962). Ordinary Least Squares regression models with lagged dependent variables showed that foster parents ≥60 had deteriorating physical health over time, but caregiver age alone had no association with worsening mental health. However, parents ≥60 caring for children with externalizing behavioural problems had significantly improved physical health. Mental health of parents ≥60 significantly diminished if child externalizing or internalizing problems worsened. Findings indicate that for aging foster parents, externalizing child behaviours may stimulate physical activity and improved physical health, yet any type of child behavioural problem can deteriorate mental health functioning.     

Gender and health among older people: What is the role of social policies?

The study investigated how social policies moderate the association between gender and health among older people across European countries. The study is the first to take a comprehensive view on the role of social policies in connection with gender inequality in health among older Europeans. The association between gender and poor self‐rated health and limiting long‐standing illness was investigated in a multilevel framework. Cross‐level interaction effects showed that more generous minimum pensions, higher spending on eldercare and a higher degree of eldercare formalisation are associated with relatively better health among women, while more generous standard pensions are associated with relatively better health among men. The conclusion is that policies directed towards older people are not gender neutral; rather they are likely to affect men and women differently. By shaping the distribution of resources as well as of unpaid work, social policies can contribute to either strengthening or weakening the link between gender and health.     

Influence of positive development opportunities on student well-being,depression and suicide risk: the New Zealand Youth Health and Well-being Survey 2012

This study explores the association between neighbourhood opportunities for Positive Youth Development (PYD) and adolescent depressive symptoms, well-being and suicide risk. A 2-stage random sample of 8500 students(years 9–13) from 91 high schools from throughout New Zealand was collected in 2012. Analyses were restricted to neighbourhoods with more than 10 students resulting in a final sample of 5191 adolescents within 266 neighbourhoods. Multilevel models linked data from neighbourhoods to individual student data to explore the association between neighbourhood opportunities for PYD and student depressive symptoms, well-being and suicide risk. Neighbourhoods with a high proportion of students involved in activities that help others, attend church groups, or participate in sports teams were associated with significantly increased well-being among students living in these neighbourhoods. No neighbourhood-level measures were found to significantly alter rates of depressive symptoms or suicide risk. Findings suggest that providing neighbourhood opportunities for PYD may enhance adolescent well-being.     

Employment status,material hardship,and mental health among low-income working-age adults in South Korea

The current study examines the associations between employment status and mental health and the mediating role of material hardship among low-income households in South Korea. This study uses regression models with a rich set of control variables and lagged dependent variable models with a nationally representative sample of 1113 low-income working-age household heads from the Korean Welfare Panel Study (KOWEPS). We find that the nonstandard employment and unemployment statuses are associated with a higher level of depression and a lower level of self-esteem, when compared to a standard employment status. These negative associations are partially mediated by an increased material hardship risk. Policy implications to improve employment conditions and mitigate material hardship are discussed.