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Articles   |    
Employment Status of People With Mental Illness: National Survey Data From 2009 and 2010
Alison Luciano, Ph.D.; Ellen Meara, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300335
View Author and Article Information

Dr. Luciano is with the Dartmouth Psychiatric Research Center and Dr. Meara is with the Dartmouth Institute for Health Policy and Clinical Practice, both at Geisel School of Medicine at Dartmouth, Hanover, New Hampshire (e-mail: alison.luciano.gr@dartmouth.edu). Dr. Meara is also with the National Bureau of Economic Research, Cambridge, Massachusetts.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objective  The aim of this study was to describe employment according to mental illness severity in the United States during 2009 and 2010.

Methods  The sample included all working-age participants (ages 18–64) from the 2009 and 2010 National Survey on Drug Use and Health (N=77,326). Two well-established scales of mental health distinguished participants with none, mild, moderate, and serious mental illness. Analyses compared employment rate and income by mental illness severity. Employment status was estimated with logistic regression models that controlled for demographic characteristics and substance use disorders. In secondary analyses the relationship between mental illness and employment was assessed for variation by age and education status.

Results  Employment rates decreased with increasing mental illness severity (no mental illness, 75.9% employment; mild, 68.8%; moderate, 62.7%; and serious, 54.5%, p<.001). Over a third of people with serious mental illness, 38.5%, had incomes <$10,000 (compared with 23.1% of people with no mental illness, p<.001). The gap in adjusted employment rates comparing persons with serious versus no mental illness was 1% among people 18–25 years old versus 21% among people 50–64 (p<.001).

Conclusions  More severe mental illness was associated with lower employment rates in 2009 and 2010. People with serious mental illness are less likely than people with no, mild, or moderate mental illness to be employed after age 49.

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Figure 1 Employment rates among adults 18–64, by mental health status, 2009–2010a

aSource: National Survey on Drug Use and Health, 2009 and 2010. Percentages are weighted to be nationally representative.

Figure 2 Employment rates among adults 18–64, by age within mental health status groups, 2009–2010a

aSource: National Survey on Drug Use and Health, 2009 and 2010. Percentages are adjusted predicted probabilities based on logistic regression models stratified by mental health status, with adjustment for age, gender, education, marital status, race-ethnicity, substance use disorders, self-reported general health, number of children in household, arrests in past year, and county type. Full model results are available in Table 3.

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Table 1Demographic characteristics of adults 18–64, by mental health status, 2009–2010a
Table Footer Note

a Source: National Survey on Drug Use and Health, 2009 and 2010. Values are expressed as crude Ns and adjusted percentages. Proportions are weighted to be nationally representative. All p values for chi square test of differences across mental illness severity groups were statistically significant (p<.001).

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Table 2Employment and income of adults 18–64, by mental health status, 2009–2010a
Table Footer Note

a Source: National Survey on Drug Use and Health, 2009 and 2010. Values are expressed as crude Ns and adjusted percentages. Proportions are weighted to be nationally representative. All p values for chi square test of differences across mental illness severity groups were statistically significant (p<.001).

Table Footer Note

b Among persons employed full- or part-time in the past year

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Table 3Employment rates among adults 18–64, by mental health status and predictors of employment, 2009–2010a
Table Footer Note

a Source: National Survey on Drug Use and Health, 2009–2010. Percentages are adjusted predicted probabilities based on logistic regression models stratified by mental illness severity groups. Odds ratios and confidence intervals for the adjusted relationship between mental illness severity and employment status are reported in the online data supplement to this article.

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References

Frank RG, Koss C: Mental Health and Labor Markets Productivity Loss and Restoration. Working Paper No 38. Geneva, World Health Organization, 2005. Available at www.dcp2.org/file/50/wp38.pdf
 
Wu  EQ;  Birnbaum  HG;  Shi  L  et al:  The economic burden of schizophrenia in the United States in 2002.  Journal of Clinical Psychiatry 66:1122–1129, 2005
[CrossRef] | [PubMed]
 
Baldwin  ML;  Marcus  SC:  Labor market outcomes of persons with mental disorders.  Industrial Relations 46:481–510, 2007
 
Kessler  RC;  Heeringa  S;  Lakoma  MD  et al:  Individual and societal effects of mental disorders on earnings in the United States: results from the National Comorbidity Survey Replication.  American Journal of Psychiatry 165:703–711, 2008
[CrossRef] | [PubMed]
 
Blyler  CR:  Employment and Major Depressive Episode .  Rockville, Md,  Substance Abuse and Mental Health Services Administration, 2009
 
Cowell  AJ;  Luo  Z;  Masuda  YJ:  Psychiatric disorders and the labor market: an analysis by disorder profiles.  Journal of Mental Health Policy and Economics 12:3–17, 2009
[PubMed]
 
Burnett-Zeigler  I;  Ilgen  MA;  Bohnert  K  et al:  The impact of psychiatric disorders on employment: results from a national survey (NESARC).  Community Mental Health Journal 49:303–310, 2013
[CrossRef] | [PubMed]
 
Pratt  LA:  Characteristics of adults with serious mental illness in the United States household population in 2007.  Psychiatric Services 63:1042–1046, 2012
[CrossRef] | [PubMed]
 
Levinson  D;  Lakoma  MD;  Petukhova  M  et al:  Associations of serious mental illness with earnings: results from the WHO World Mental Health surveys.  British Journal of Psychiatry 197:114–121, 2010
[CrossRef] | [PubMed]
 
Mechanic  D;  Blider  S;  McAlpine  DD:  Employing persons with serious mental illness.  Health Affairs 21(5):242–253, 2002
[CrossRef] | [PubMed]
 
Warr  P:  Work, Unemployment, and Mental Health .  Oxford,  Oxford University Press, 1987
 
Blustein  DL:  The role of work in psychological health and well-being: a conceptual, historical, and public policy perspective.  American Psychologist 63:228–240, 2008
[CrossRef] | [PubMed]
 
Fogg  NP;  Harrington  PE;  McMahon  BT:  The impact of the Great Recession upon the unemployment of Americans with disabilities.  Journal of Vocational Rehabilitation 33:193–202, 2010
[CrossRef]
 
Barr  B;  Taylor-Robinson  D;  Scott-Samuel  A  et al:  Suicides associated with the 2008–10 economic recession in England: time trend analysis.  BMJ 345:e5142, 2012
[CrossRef] | [PubMed]
 
Cook  JA;  Blyler  CR;  Leff  HS  et al:  The employment intervention demonstration program: major findings and policy implications.  Psychiatric Rehabilitation Journal 31:291–295, 2008
[CrossRef] | [PubMed]
 
Fabian  ES:  Work and the quality of life.  Psychosocial Rehabilitation Journal 12:39–49, 1989
[CrossRef]
 
Fabian  ES:  Supported employment and the quality of life: does a job make a difference? Rehabilitation Counseling Bulletin 36:84–97, 1992
 
Arns  PG;  Linney  JA:  Work, self, and life satisfaction for persons with severe and persistent mental disorders.  Psychosocial Rehabilitation Journal 17:63–79, 1993
[CrossRef]
 
Arns  PG;  Linney  JA:  The relationship of service individualization to client functioning in programs for severely mentally ill persons.  Community Mental Health Journal 31:127–137, 1995
[CrossRef] | [PubMed]
 
Van Dongen  CJ:  Self-esteem among persons with severe mental illness.  Issues in Mental Health Nursing 19:29–40, 1998
[CrossRef] | [PubMed]
 
Cook  JA;  Razzano  L:  Vocational rehabilitation for persons with schizophrenia: recent research and implications for practice.  Schizophrenia Bulletin 26:87–103, 2000
[CrossRef] | [PubMed]
 
Gaebel  W;  Pietzcker  A:  Prospective study of course of illness in schizophrenia: part II. prediction of outcome.  Schizophrenia Bulletin 13:299–306, 1987
[CrossRef] | [PubMed]
 
Bond  GR;  Dietzen  LL;  Vogler  KM  et al:  Toward a framework for evaluating costs and benefits of psychiatric rehabilitation: three case examples.  Journal of Vocational Rehabilitation 5:75–88, 1995
[CrossRef]
 
Burns  T;  Catty  J;  White  S  et al:  The impact of supported employment and working on clinical and social functioning: results of an international study of individual placement and support.  Schizophrenia Bulletin 35:949–958, 2009
[CrossRef] | [PubMed]
 
Clark  RE:  Supported employment and managed care: can they coexist? Psychiatric Rehabilitation Journal 22:62–68, 1998
[CrossRef]
 
Henry  AD;  Lucca  AM;  Banks  SM  et al:  Inpatient hospitalizations and emergency service visits among participants in an Individual Placement and Support (IPS) model program.  Mental Health Services Research 6:227–237, 2004
[CrossRef] | [PubMed]
 
Latimer  E:  Economic impacts of supported employment for the severely mentally ill.  Canadian Journal of Psychiatry 46:496–505, 2001
 
Perkins  DV;  Born  DL;  Raines  JA  et al:  Program evaluation from an ecological perspective: supported employment services for persons with serious psychiatric disabilities.  Psychiatric Rehabilitation Journal 28:217–224, 2005
[CrossRef] | [PubMed]
 
Schneider  J;  Boyce  M;  Johnson  R  et al:  Impact of supported employment on service costs and income of people with mental health needs.  Journal of Mental Health 18:533–542, 2009
[CrossRef]
 
Burkhauser  RV;  Daly  M:  The Declining Work and Welfare of People With Disabilities .  Washington, DC,  American Enterprise Institute for Public Policy Research, 2011
 
Labor Force Statistics From the Current Population Survey. Washington, DC, US Department of Labor, Bureau of Labor Statistics, 2013. Available from data.bls.gov/timeseries/LNS14000000
 
Autor  DH;  Duggan  MG:  The growth in the Social Security Disability rolls: a fiscal crisis unfolding.  Journal of Economic Perspectives 20:71–96, 2006
[CrossRef] | [PubMed]
 
Drake  RE;  Bond  GR;  Becker  DR:  Individual Placement and Support: An Evidence-Based Approach to Supported Employment .  New York,  Oxford University Press, 2012
 
Goodman  N;  Stapleton  D:  Federal program expenditures for working-age people with disabilities.  Journal of Disability Policy Studies 18(2):66–78, 2007
[CrossRef]
 
McAlpine  DD;  Warner  L:  Barriers to Employment Among Persons With Mental Illness: A Review of the Literature .  New Brunswick, NJ,  Rutgers University, Institute for Health, Health Care Policy and Aging Research, Center for Research on the Organization and Financing of Care for the Severely Mentally Ill, 2002
 
Hennessey  JC;  Dykacz  JM:  Projected outcomes and length of time in the Disability Insurance program.  Social Security Bulletin 52:2–41, 1989
[PubMed]
 
The Business Cycle Dating Committee Meeting Minutes. Cambridge, Mass, National Bureau of Economic Research, 2010. Available at www.nber.org/cycles/sept2010.html
 
 Employment Status of the Civilian Noninstitutional Population 16 to 24 Years of Age by Sex, Race, and Hispanic or Latino Ethnicity, July 2010–2013 .  Washington, DC,  US Department of Labor, Bureau of Labor Statistics, 2013
 
Becker DR, Swanson SJ, Bond GR, et al: Evidence-Based Supported Employment Fidelity Review Manual. Hanover, NH, Dartmouth Psychiatric Research Center, 2011. Available at delawareebse.pbworks.com/f/EB%20Supported%20Employment%20Fidelity%20Review%20Manual.pdf
 
Luciano  A;  Drake  RE;  Bond  GR  et al:  Evidence-based supported employment for people with severe mental illness: past, current, and future research.  Journal of Vocational Rehabilitation 40(1):1–13, 2014
 
Cimera  RE:  The cost-effectiveness of supported employment and sheltered workshops in Wisconsin (FY 2002–FY 2005).  Journal of Vocational Rehabilitation 26:153–158, 2007
 
Results from the 2010 National Survey on Drug Use and Health: Summary of National Findings. HHS pub no SMA 11-4658. Rockville, Md, Substance Abuse and Mental Health Services Administration, 2011
 
Number of Social Security Beneficiaries. Washington, DC, Social Security Administration, 2012. Available at www.ssa.gov/oact/progdata/icpGraph.html
 
Furukawa  TA;  Kessler  RC;  Slade  T  et al:  The performance of the K6 and K10 screening scales for psychological distress in the Australian National Survey of Mental Health and Well-Being.  Psychological Medicine 33:357–362, 2003
[CrossRef] | [PubMed]
 
Kessler  RC;  Barker  PR;  Colpe  LJ  et al:  Screening for serious mental illness in the general population.  Archives of General Psychiatry 60:184–189, 2003
[CrossRef] | [PubMed]
 
Rehm  J;  Üstün  TB;  Saxena  S  et al:  On the development and psychometric testing of the WHO screening instrument to assess disablement in the general population.  International Journal of Methods in Psychiatric Research 8:110–122, 1999
[CrossRef]
 
Novak  SP;  Colpe  LJ;  Barker  PR  et al:  Development of a brief mental health impairment scale using a nationally representative sample in the USA.  International Journal of Methods in Psychiatric Research 19(suppl 1):49–60, 2010
[CrossRef] | [PubMed]
 
Colpe  LJ;  Barker  PR;  Karg  RS  et al:  The National Survey on Drug Use and Health Mental Health Surveillance Study: calibration study design and field procedures.  International Journal of Methods in Psychiatric Research 19(suppl 1):36–48, 2010
[CrossRef] | [PubMed]
 
Aldworth  J;  Colpe  LJ;  Gfroerer  JC  et al:  The National Survey on Drug Use and Health Mental Health Surveillance Study: calibration analysis.  International Journal of Methods in Psychiatric Research 19(suppl 1):61–87, 2010
[CrossRef] | [PubMed]
 
Tsang  HW;  Leung  AY;  Chung  RC  et al:  Review on vocational predictors: a systematic review of predictors of vocational outcomes among individuals with schizophrenia: an update since 1998.  Australian and New Zealand Journal of Psychiatry 44:495–504, 2010
[CrossRef] | [PubMed]
 
Hamilton  VH;  Merrigan  P;  Dufresne  É:  Down and out: estimating the relationship between mental health and unemployment.  Econometrics and Health Economics 6:397–406, 1997
[CrossRef]
 
Frank  R;  Gertler  P:  An assessment of measurement error bias for estimating the effect of mental distress on income.  Journal of Human Resources 26:154–164, 1991
[CrossRef]
 
Labor Force Participation Rates by Marital Status, Sex, and Age: 1970 to 2010. Washington, DC, US Department of Labor, Bureau of Labor Statistics, 2011
 
Alexandre  PK;  French  MT:  Labor supply of poor residents in metropolitan Miami, Florida: the role of depression and the co-morbid effects of substance use.  Journal of Mental Health Policy and Economics 4:161–173, 2001
[PubMed]
 
Apel  R;  Sweeten  G:  The impact of incarceration on employment during the transition to adulthood.  Social Problems 57:448–479, 2010
[CrossRef]
 
Bond  GR;  Drake  RE;  Becker  DR:  Generalizability of the Individual Placement and Support (IPS) model of supported employment outside the US.  World Psychiatry 11:32–39, 2012
[CrossRef] | [PubMed]
 
A History of the Social Security Disability Programs. Washington, DC, Social Security Administration, 1986. Available at www.ssa.gov/history/1986dibhistory.html. Accessed May 22, 2014
 
Kinn  LG;  Holgersen  H;  Aas  RW  et al:  ‘‘Balancing on skates on the icy surface of work’’: a metasynthesis of work participation for persons with psychiatric disabilities.  Journal of Occupational Rehabilitation 24:125–138, 2014
[CrossRef] | [PubMed]
 
Auslander  LA;  Jeste  DV:  Perceptions of problems and needs for service among middle-aged and elderly outpatients with schizophrenia and related psychotic disorders.  Community Mental Health Journal 38:391–402, 2002
[CrossRef] | [PubMed]
 
Eide  ER;  Showalter  MH:  Human capital; in  International Encyclopedia of Education , 3rd ed. Edited by Peterson  P;  Baker  E;  McGaw  B.  Oxford, England,  Elsevier, 2010
 
Michon  HW;  van Weeghel  J;  Kroon  H  et al:  Person-related predictors of employment outcomes after participation in psychiatric vocational rehabilitation programmes—a systematic review.  Social Psychiatry and Psychiatric Epidemiology 40:408–416, 2005
[CrossRef] | [PubMed]
 
Bond  GR;  Drake  RE:  Predictors of competitive employment among patients with schizophrenia.  Current Opinion in Psychiatry 21:362–369, 2008
[CrossRef] | [PubMed]
 
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