The Impact of Psychiatric Disorders on Labor Market Outcomes

We describe the relationship of depression and depressive symptoms to disability days and days lost from work in 2980 participants in the Epidemiologic Catchment Area Study in North Carolina after 1 year of follow-up. Compared with asymptomatic individuals, persons with major depression had a 4.78 times greater risk of disability (95% confidence interval, 1.64 to 13.88), and persons with minor depression with mood disturbance, but not major depression, had a 1.55 times greater risk (95% confidence interval, 1.00 to 2.40). Because of its prevalence, individuals with minor depression were associated with 51% more disability days in the community than persons with major depression. This group was also at increased risk of having a concomitant anxiety disorder or developing major depression within 1 year. We conclude that the threshold for identifying clinically significant depression may need to be reevaluated to include persons with fewer symptoms but measurable morbidity. Only by changing our nosology can the societal impact of depression be adequately addressed.

Married women have been found consistently to have higher rates of anxious and depressive symptoms than married men. Power explanations for this difference predict that employment for women, which is associated with greater power in the family, would reduce women's symptoms to approximate men's more closely. Results on the effects of women's employment, however, are inconsistent. One explanation for this inconsistency concerns role overload, or the greater demands experienced by women with employment. This paper proposes that overload creates greater symptoms for the same reason as low power; that is, through lowering individuals' sense of personal control. Thus employment for women is not consistently positive because it often trades one source of low control for another. We test a personal control explanation for the effects of women's employment, using community surveys of mental health. Results indicate that issues of personal control underlie the effects of both high demands and low power on sex differences in anxious and depressive symptoms.