Mental health selection and income support dynamics: multiple spell discrete-time survival analyses of welfare receipt.
BACKGROUND
The higher occurrence of common psychiatric disorders among welfare recipients has been attributed to health selection, social causation and underlying vulnerability. The aims of this study were to test for the selection effects of mental health problems on entry and re-entry to working-age welfare payments in respect to single parenthood, unemployment and disability.


METHODS
Nationally representative longitudinal data were drawn from the Household Income and Labour Dynamics in Australia survey. Multiple spell discrete-time survival analyses were conducted using multinomial logistic regression models to test if pre-existing mental health problems predicted transitions to welfare. Analyses were stratified by sex and multivariate adjusted for mental health problems, father's occupation, socioeconomic position, marital status, employment history, smoking status and alcohol consumption, physical function and financial hardship. All covariates were modelled as either lagged effects or when a respondent was first observed to be at risk of income support.


RESULTS
Mental health problems were associated with increased risk of entry and re-entry to disability, unemployment and single parenting payments for women, and disability and unemployment payments for men. These associations were attenuated but remained significant after adjusting for contemporaneous risk factors.


CONCLUSIONS
Although we do not control for reciprocal causation, our findings are consistent with a health selection hypothesis and indicate that mental illness may be a contributing factor to later receipt of different types of welfare payments. We argue that mental health warrants consideration in the design and targeting of social and economic policies.
['Kiely|Kim M|KM|', 'Butterworth|Peter|P|']
D000368:Aged D001315:Australia D003430:Cross-Sectional Studies D006233:Disabled Persons D005260:Female D006801:Humans D007182:Income D008137:Longitudinal Studies D008297:Male D001523:Mental Disorders D008603:Mental Health D008875:Middle Aged D011632:Public Assistance D012307:Risk Factors D015406:Single Parent D012946:Social Welfare D012959:Socioeconomic Factors D013315:Stress, Psychological D014478:Unemployment D035862:Vulnerable Populations D055815:Young Adult
MENTAL HEALTH UNEMPLOYMENT Cohort studies Health inequalities Social and life-course epidemiology