How much of the unemployment effect on mental health is due to income? Mediation analysis in UK data

Abstract Background Employment and income are important determinants of mental health (MH), but the extent to which unemployment effects are mediated by reduced income is unclear. We estimated the total effect (TE) of unemployment on MH and the controlled direct effect (CDE) not acting via income. Methods We studied adults 25-64y from nine waves of the representative UK Household Longitudinal Study (n = 45,497/obs=202,297). Unemployment was defined as not being in paid employment; common mental disorder (CMD) was defined as a General Health Questionnaire-12 score ≥4. We conducted causal mediation analysis using inverse probability of treatment weights to estimate odds ratios (OR) and absolute differences for the effects of unemployment on CMD as measured in the same sweep, before (TE) and after (CDE) blocking the income pathway. The percentage mediated by income was 100*(TE-CDE)/TE, with standard errors calculated via bootstrapping. Multiple imputation addressed missingness. Results The TE of unemployment on short-term CMD risk was OR: 1.66 (95% CI 1.57-1.76), with 7.09% (6.21-7.97) absolute difference in prevalence; equivalent CDEs were OR 1.55 (1.46-1.66) and 6.08% (5.13-7.03). Income mediated 14.22% (8.04-20.40) of the TE. Percentage mediation was higher for job losses (15.10% [6.81-23.39]) than job gains (8.77% [0.36-17.19]). Mediation by income was lowest for those aged 25-40y (7.99% [-2.57, 18.51]) and those in poverty (2.63% [-2.22, 7.49]). Conclusions In the UK, a high proportion of the short-term effect of unemployment on MH is not explained by income, particularly for those who are younger or already living in poverty. Population attributable fractions suggested 16.5% of CMD burden was due to unemployment, with 13.9% directly attributable to job loss rather than resultant income changes. Further research is needed across different European countries to determine how different welfare regimes might moderate these effects, and to investigate longer-term effects. Key messages • Unemployment has a clear detrimental effect on MH in the short-term. • Only a small proportion of this effect appears to be mediated by income.

and type 2 diabetes (T2DM). The objective of this study was to quantify the potential long-term health and economic impact of different SSBs taxation scenarios in Germany using simulation models with different granularity.

Methods:
We used a multi-state life table Markov cohort (MSLT) and a microsimulation (IMPACT) model to simulate the impact of different SSB taxation assumptions and scenarios on CVD and T2DM in the German population aged 20 years and older over 20 years. Data sources included official population counts, anthropometric and dietary intake data from national surveys and published meta-analyses. Change in beverage consumption by sex and age under different taxation scenarios was estimated using de-novo national price elasticities and changes in body weight were based on an energy equilibrium model. We projected incremental disability-adjusted life years (DALYs) and healthcare costs, comparing results between both models.

Results:
Preliminary results from the MSLT model show that a 20% SSB excise tax in Germany could lead to moderate body weight reductions across all age-sex groups. Over 20 years, the tax would reduce healthcare costs by E753 million [95% CI: 527; 1,021] and save 24,380 DALYs [18,460; 33,900] from T2DM alone. Health and economic gains largely depend on the relevance of substitution effects, tax amount and taxed beverage categories. Results including CVD and comparisons with the IMPACT model are work-in-progress.

Conclusions:
We show that SSBs taxation in Germany has the potential to reduce healthcare costs and improve population health. The impact of any SSB tax depends on its implementation scenario, which behavioural assumptions hold, and the obesity-related disease outcomes considered for its evaluation. Further research should compare various obesity prevention approaches to support health policy priority setting.

Key messages:
Taxation of sugar-sweetened beverages can reduce healthcare costs and improve population health in Germany. The estimated health and economic impact of sugarsweetened beverage taxation critically depends on tax design and behavioural modelling assumptions.

Background:
Employment and income are important determinants of mental health (MH), but the extent to which unemployment effects are mediated by reduced income is unclear. We estimated the total effect (TE) of unemployment on MH and the controlled direct effect (CDE) not acting via income.

Methods:
We studied adults 25-64y from nine waves of the representative UK Household Longitudinal Study (n = 45,497/ obs = 202,297). Unemployment was defined as not being in paid employment; common mental disorder (CMD) was defined as a General Health Questionnaire-12 score !4. We conducted causal mediation analysis using inverse probability of treatment weights to estimate odds ratios (OR) and absolute differences for the effects of unemployment on CMD as measured in the same sweep, before (TE) and after (CDE) blocking the income pathway. The percentage mediated by income was 100 Ã (TE-CDE)/TE, with standard errors calculated via bootstrapping. Multiple imputation addressed missingness.

Results:
The TE of unemployment on short-term CMD risk was OR:

Conclusions:
In the UK, a high proportion of the short-term effect of unemployment on MH is not explained by income, particularly for those who are younger or already living in poverty. Population attributable fractions suggested 16.5% of CMD burden was due to unemployment, with 13.9% directly attributable to job loss rather than resultant income changes. Further research is needed across different European countries to determine how different welfare regimes might moderate these effects, and to investigate longer-term effects. Key messages: Unemployment has a clear detrimental effect on MH in the short-term. Only a small proportion of this effect appears to be mediated by income.