Unemployment pre-dates symptoms of depression and anxiety resulting in medical consultation in young men

Background There is evidence To support a link between unemployment and low er levels of psychological well-being, bur debate continues as to whether u nemployment results in psychological morbidity, or whether the association is due to those who are more vulnerable to mental illness becoming unemploy ed. Here we assess the effect of recent and accumulated unemployment in you ng men on the risk of developing depression and anxiety leading to medical consultation. Adjustment was made for a measure of pre-existing tendency to depression, behavioural maladjustment, social class, qualifications and re gion of residence. Methods Some 3241 men from the National Child Development Study (the 1958 B ritish birth cohort) with data from birth to age 33 years, collected at bir th and ages 7, 11, 16, 23 and 33 years were used in these analyses. The out come measure was onset age of anxiety or depression between ages 24 and 33 years, that resulted in consultation with a GP or a specialist. This was us ed in Cox proportional hazards models where two measures of unemployment we re modelled as time varying covariates. Pre-existing tendency to depression was measured by the Malaise Inventory prior to the experience of unemploym ent at age 23 years. Two measures of unemployment were investigated: any un employment in the year prior to onset (recent unemployment) and all accumul ated unemployment prior to onset (divided into four categories: 0, 1-12, 13 -36 and 37+ months of unemployment). Results After adjustment for potential confounding factors including pre-ex isting tendency to depression, the relative risk (RR) for developing sympto ms resulting in consultation was 2.10 (95% CT: 1.21-3.63), when those who w ere unemployed in the year prior to onset were compared with those who were not. Accumulated unemployment was not statistically significantly related to onset of symptoms in all men after adjustment for the potential confound ing factors: an RR of 1.63 (95% CI:0.95-2.79) for men with 37+ months of ac cumulated unemployment when compared with none. However exclusion of men wi th a pre-existing tendency to depression indicated by the Malaise Inventory score, increased the RR to 2.30 (95% CI:1.44-3.65) for recent unemployment and 2.04 (95% CI:1.17-3.54) for 37+ months of accumulated unemployment whe n compared with none. Conclusions Unemployment is a risk factor for psychological symptoms of dep ression requiring medical attention, even in those men without previous psy chological vulnerability.