ABSTRACT
Introduction: This study examines: (1) the employment rate among those with a mental disorder in the 12 months preceding the survey (referred henceforth as 12-month mental disorder); (2) the sociodemographic correlates of unemployment; and (3) the association of unemployment with 12-month mental disorders and chronic physical conditions in the adult resident population in Singapore. Methods: Data are from the Singapore Mental Health Study 2016, a household survey of a nationally representative sample of 6,126 Singapore residents. The Composite International Diagnostic Interview (CIDI) was used to assess mental disorders and physical health conditions. Employment-related information was collected using a modified employment module of the CIDI. Results: Of the 6,125 participants who took part in the study, 4,055 (72%) were employed, 1,716 (22.7%) were economically inactive, and 354 (5.3%) were unemployed. The unemployment rate was twice as high among those with a 12-month mental disorder (11.5%) than those without (4.8%). The proportion of unemployed individuals increased sharply with the increasing severity of mental disorders. Being married and higher household income were significantly associated with a higher likelihood of being employed than unemployed. In contrast, the presence of one 12-month mental disorder was significantly associated with a lower likelihood of being employed. Conclusion: Our findings provide information on the significant association of mental disorders with unemployment. Clinicians should remain vigilant and consider the loss of employment a potential risk factor for adverse physical and mental health changes. Management of unemployed patients with a combination of pharmacotherapy and work-directed interventions can facilitate their re-entry into the workforce and improve health outcomes.
Several reviews and meta-analyses have established an association between unemployment and psychological distress. This relationship between unemployment and mental health is complex and likely bidirectional. On the one hand, unemployment may lead to psychological distress and mental disorders (social causation), but on the other, those with poor mental health may struggle to find a foothold in the labour market (health selection). Jahoda’s latent deprivation model has been widely used to explain the relationship between unemployment and psychological distress. The author postulates that the latent functions of employment—such as providing structure to the day, enabling social contact, and contributing to collective purpose—satisfy individuals’ important psychological needs. Unemployment deprives people of these benefits, leading to psychological distress. Fryer alternatively emphasised the contribution of the manifest function of employment, namely, financial income to well-being; the loss of employment resulted in poverty, loss of agency, and subsequent psychological distress.
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