Severe Mental Illness and Economic Inactivity, Disability Linked in Cohort Study

Individuals living with severe mental illnesses (SMI) have high rates of economic inactivity, disability, and poor health, according to results of a study published in Schizophrenia Bulletin.

Individuals living with SMI have been reported to have significant disparities related with employment and health, however, few population-based studies have been published.

To that aim, researchers conducted a cohort study examining the association between employment, disability, and health outcomes among individuals with SMI. Data for this study was sourced from the South London and Maudsley Mental Health Trust and United Kingdom (UK) Census. Individuals aged 16 years or older diagnosed with schizophrenia-spectrum or bipolar affective disorder before March 2011 or not were evaluated for economic and health status. Employment was defined as working 15 hours or more in the preceding week and disability and health status were defined by 2 ordinal self-reported outcomes in the UK Census.

In total, 8249 individuals were identified as having an SMI diagnosis. Of these, 51% were men or boys, 7.1% were aged 15 to 24; 22.7% were employed, 31.7% had no disability, and 38.9% had good health. Additionally of those with SMI, 31% had an affective diagnosis, 68% lived in rental housing; 27% had no educational qualifications; and 48% were White British.

The patients with SMI had been diagnosed a median of 4.6 (IQR, 2.3-7.5) years previously.

Among individuals with SMI, economic inactivity was associated with receiving SMI diagnosis 10 years ago or more compared with that year (aOR, 2.14), having a history of substance misuse (aOR, 1.93), having a history of mental health admission (aOR, 1.79), living alone (aOR, 1.72), never marrying (aOR, 1.66), being diagnosed at 45 to 64 years of age compared with before 45 years of age (aOR, 1.39), Index of Multiple Deprivation (IMD) quartiles 4 or 3 compared with one (aOR range, 1.26-1.31), and other Black (aOR, 1.98), South Asian (aOR, 1.66), and Black African (aOR, 1.60) race compared with White British.

Self-rated poor health was associated with being diagnosed at 45 years of age or after (aOR range, 1.86-2.39), receiving SMI diagnosis 10 years ago or more compared with that year (aOR, 1.54), living alone (aOR, 1.32), and having a history of substance misuse (aOR, 1.32).

Self-rated disability was associated with being diagnosed at 45 years of age or after (aOR range, 1.56-1.92), receiving SMI diagnosis 7 years ago or more compared with that year (aOR range, 1.59-1.88), living alone (aOR, 1.48), having a history of substance misuse (aOR, 1.32), and never marrying (aOR, 1.27).

The features that were inversely related with economic inactivity, poor health, and disability included having educational qualifications (aOR range, 0.12-0.67) and owning residence compared with renting (aOR range, 0.24-0.77).

The study authors concluded, “Our findings demonstrate stark inequities with respect to these outcomes and suggests possible mechanisms (i.e., through social isolation, socioeconomic adversity, and lower education) that warrant further examination and which could be targeted to improve outcomes for this group of people.”

This study was limited by not having updated Census data.

Disclosure: One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

This article originally appeared on Psychiatry Advisor