Employment status, mental disorders and service use in the working age population

Objectives: This study examined the association between employment status and specific DSM-IV (Diagnostic and Statistical Manual for Mental Disorders, IVth edition) depressive, anxiety and alcohol use disorders and the association between employment status and service use for these disorders. Methods: As part of the representative population-based "Health 2000 Study" of Finns aged 30 years or over, 3440 employed, 429 unemployed, and 820 economically inactive persons of working age (30-64 years) participated in a comprehensive health examination, including the standardized Composite International Diagnostic Interview. Results: The risk of mental disorders was generally higher among the unemployed and the economically inactive than among the employed. The respective odds ratios were 1.79 [95% confidence interval (95% CI) 1.26-2.54] and 1.54 (95% CI 1.06-2.25) for depressive disorders, 2.68 (95% CI 1.85-3.89) and 2.53 (95% CI 1.76-3.65) for anxiety disorders, and 2.58 (95% CI 1.82-3.65) and 1.43 (95% CI 0.91-2.22) for alcohol use disorders. Similar results were obtained for most of the specific categories of these disorders. Among the persons with anxiety disorders, the odds for treatment contact were 2.35 (95% CI 1.06-5.23) times higher for the unemployed than for the employed after control for disorder severity. For those with an alcohol use disorder, the corresponding odds ratio was 3.51 (95% CI 1.23-9.98). Conclusions: Common mental disorders are less prevalent among the employed than among unemployed and economically inactive people. Among those with anxiety or alcohol use disorders, service use is less common among the employed than among the unemployed. This difference is not explained by the severity of the clinical state.