Skip Navigation


Occupational Medicine Advance Access originally published online on January 16, 2007
Occupational Medicine 2007 57(3):217-220; doi:10.1093/occmed/kql177
This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
57/3/217    most recent
kql177v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Okoro, C.
Right arrow Articles by Mokdad, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Okoro, C.
Right arrow Articles by Mokdad, A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The Author 2007. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Short Reports

Employment status and frequent mental distress among adults with disabilities

Catherine Okoro1, Tara Strine2, Lisa McGuire1, Lina Balluz1 and Ali Mokdad1

1 Division of Adult and Community Health, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
2 Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA

Correspondence to: Catherine Okoro, Division of Adult and Community Health, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop K66, Atlanta, GA 30341, USA. Tel: +1 770 488 2477; fax: +1 770 488 8150; e-mail: cao0{at}cdc.gov


   Abstract
Top
 Abstract
Introduction
 Methods
 Results
 Discussion
 Disclaimer
 Conflicts of interest
 References
 
Background It has been postulated that poor mental health can lead to disability and disability can lead to unemployment. However, the association between poor mental health and employment status among adults with disabilities has not been well characterized in population-based studies.

Aim To examine the association between employment status and frequent mental distress (FMD; 14 or more mentally unhealthy days during the previous 30 days) among adults with disabilities.

Methods Cross-sectional data were analysed for 47 377 community-dwelling US adults aged 25–64 years with disabilities that participated in the 2001 and 2003 Behavioural Risk Factor Surveillance System. Logistic regression analysis was applied.

Results Among adults with disabilities, the unadjusted prevalence of FMD was 18% (SE 0.4) among those employed, 40% (SE 1.3) among those unemployed and 44% (SE 0.8) among those unable to work. After adjustments were made for age, sex and race/ethnicity, the results indicated that adults with disabilities who were unemployed or unable to work were significantly more likely than those employed to have FMD (adjusted prevalence: 39 and 45%, respectively, versus 18%; P < 0.001). These associations persisted after further adjusting for education, marital status, health risk behaviours, body mass index, health care coverage and self-rated general health (34 and 36%, respectively, versus 19%; P < 0.001).

Conclusion These findings demonstrate the need for research and development of public health interventions to reduce the toll of mental distress among all adults with disabilities.

Keywords      Disabilities; disabled adults; employment status; frequent mental distress; mental health


   Introduction
Top
 Abstract
 Introduction
Methods
 Results
 Discussion
 Disclaimer
 Conflicts of interest
 References
 
Within the coming decades, an increase is expected in the proportion of workers with disabilities due to the ageing workforce, the impact of policy changes in health care and welfare reform and the implementation of anti-discrimination laws [1–3]. Maintaining employment among persons with disabilities is related to a better quality of life and is beneficial to the community and labour market [4,5]. Furthermore, disabilities that negatively affect a person's ability to work have an enormous negative psychosocial impact on disabled employees [6]. Frequent mental distress (FMD) is a measure of perceived mental health that is believed to be associated with health behaviours related to chronic disease and disability [7]. The aim of this study was to examine the association between employment status and FMD among adults, aged 25–64 years, with disabilities using 2001 and 2003 Behavioural Risk Factor Surveillance System (BRFSS) data.


   Methods
Top
 Abstract
 Introduction
 Methods
Results
 Discussion
 Disclaimer
 Conflicts of interest
 References
 
The BRFSS, a state-based system of health surveys, was established in the USA by the Centers for Disease Control and Prevention (CDC) and state health departments in 1984 [8]. It represents the community-dwelling US population aged ≥18 years. All procedures followed the ethical standards of the CDC's Institutional Review Board (IRB). CDC's IRB was established to ensure that research involving human participants both protects the rights and welfare of study participants and conforms to US Federal regulations [9]. In 2001 and 2003, 462 799 persons from all 50 states and the District of Columbia participated in the BRFSS.

Survey participants were considered to have a disability if they answered ‘yes’ to either of two questions: (1) ‘Are you limited in any way in any activities because of physical, mental, or emotional problems?’ or (2) ‘Do you now have any health problem that requires you to use special equipment, such as a cane, a wheelchair, a special bed, or a special telephone?’

Respondents were asked the following question regarding mental health: ‘Now thinking about your mental health, which includes stress, depression and problems with emotions, for how many days during the past 30 days was your mental health not good?’ Respondents who reported 14 or more days to the previous question were defined as having FMD.

Logistic regression analysis was used to estimate the conditional marginal prevalence and odds ratios of FMD across employment categories adjusted for potential confounders. SUDAAN (Research Triangle Institute, Research Park, NC, 2001) was used to account for the complex sampling design.


   Results
Top
 Abstract
 Introduction
 Methods
 Results
Discussion
 Disclaimer
 Conflicts of interest
 References
 
Of 47 377 adults aged 25–64 years with disabilities, 61% (95% CI 60.1–61.8) were employed, 10% (95% CI 9.4–10.4) were unemployed and 29% (95% CI 28.4–30.0) were unable to work. Employed adults with disabilities were younger and more likely to be men, non-Hispanic white, more educated, married, living in the Midwest region of the USA, in a higher household income bracket and overweight than those who were unemployed or unable to work (Table 1). Additionally, employed adults with disabilities were less likely than those who were not employed to be physically inactive, current smokers, in fair/poor health and uninsured.


View this table:
[in this window]
[in a new window]

  		Table 1. Characteristics of adults aged 25–64 years with self-reported disability by employment status—BRFSS, 2001 and 2003

 
Overall, 28% (95% CI 27.0–28.5) of adults with disabilities reported experiencing FMD. The mean number of mentally unhealthy days was 5.6 (95% CI 5.5–5.8) among employed adults with disabilities compared with 11.5 (95% CI 10.9–12.2) and 12.4 (95% CI 12.0–12.8), respectively, for those who were either unemployed or unable to work. After adjusting for age, sex and race/ethnicity, adults with disabilities who were unemployed or unable to work were significantly more likely to have FMD than those who were employed (Table 2, adjusted 1 model: 39 and 45%, respectively, versus 18%; P < 0.001). Further adjustment did not substantially affect the results.


View this table:
[in this window]
[in a new window]

  		Table 2. Prevalence and odds ratios of FMD by employment status among adults aged 25–64 years with self-reported disability—BRFSS, 2001 and 2003

 

   Discussion
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
Disclaimer
 Conflicts of interest
 References
 
In this study, we found a strong association between employment status and mental distress among community-dwelling adults with disabilities. Overall, the likelihood of having FMD was slightly higher for adults with disabilities who were unable to work than for those who were unemployed. These findings clearly call for appropriate interventions to reduce the burden of mental distress among adults with disabilities.

These findings are similar to those of a previous study among non-disabled adults aged 25–64 years [10] with one exception: disabled adults who were employed were more likely to self-report alcohol abuse than those who were not employed. However, our finding is consistent with a study using data from the National Health Interview Survey Disability Supplement of 1994–95 that found self-reported alcohol abuse did not limit workforce participation [1].

The world's population is ageing [2]. Because the incidence of disability increases with age [1], the percentage of adults with disabilities in the workforce will undoubtedly increase as well. Thus, additional efforts to maintain active employment for persons with disabilities may improve their quality of life, diminish dependence on government funds [4] and enable retention of an integral segment of the workforce [5].

This study has limitations. First, the BRFSS excludes persons without telephones. Although ~95% of US households have telephones, coverage varies across states and sub-populations [8]. Second, the BRFSS excludes homeless persons and persons in institutional settings as well as those who have limitations that impede their ability to answer the telephone. Thus, our findings may underestimate the prevalence of disability and FMD. However, other research suggests that population telephone surveys do not under-represent adults with disabilities [11]. Third, persons with mental health disabilities may be more likely to report FMD than those with physical health disabilities and may be less likely to be employed. Nonetheless, we found that regardless of whether adults with disabilities reported activity limitations only, assistive technology use only or both, those who were not employed had ≥2 times the mean number of mentally unhealthy days compared to those who were employed. Finally, BRFSS data are cross-sectional, and thus causality cannot be inferred.

These limitations notwithstanding, the BRFSS has numerous strengths for making population estimates because of its standardized protocols and methodologies. Furthermore, the reliability and validity of BRFSS data have been well-documented [8].

The findings of this study provide further support for an association between employment status and mental health. Joint efforts by government, employers and the medical care system are needed to increase the societal participation of persons with disabilities and minimize the adverse effects of unemployment on mental health.


   Disclaimer
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Disclaimer
Conflicts of interest
 References
 
The findings and conclusions in this article are those of the authors and do not necessarily represent the views of the CDC.


   Conflicts of interest
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Disclaimer
 Conflicts of interest
References
 
None declared.


   Acknowledgements
 
The authors thank the state BRFSS coordinators for their help in collecting the data used in this analysis and the members of the Behavioural Surveillance Branch for their assistance in developing the database.


   References
Top
 Abstract
 Introduction
 Methods
 Results
 Discussion
 Disclaimer
 Conflicts of interest
 References
 

  1. Zwerling C, Whitten PS, Sprince NL, et al. (2002) Workforce participation by persons with disabilities: the National Health Interview Survey Disability Supplement, 1994 to 1995. J Occup Environ Med 44:358–364.[CrossRef][Web of Science][Medline]

  2. US Centers for Disease Control and Prevention. (2003) Trends in aging—United States and worldwide. Morb Mortal Wkly Rep 52:101–104 106.[Medline]

  3. Bruyère SM, Erickson WA, VanLooy S. (2004) Comparative study of workplace policy and practices contributing to disability nondiscrimination. Rehabil Psychol 49:28–38.[CrossRef][Web of Science]

  4. Findley PA and Sambamoorthi U. (2004) Employment and disability: evidence from the 1996 medical expenditures panel survey. J Occup Rehabil 14:1–11.[CrossRef][Web of Science][Medline]

  5. Mulvey J. (2003) Retirement behavior and retirement plan designs: strategies to retain an aging workforce. Benefits Q 19:25–35.[Medline]

  6. Straaton KV, Maisiak R, Wrigley JM, White MB, Johnson P, Fine PR. (1996) Barriers to return to work among persons unemployed due to arthritis and musculoskeletal disorders. Arthritis Rheum 39:101–109.[Web of Science][Medline]

  7. US Centers for Disease Control and Prevention. Measuring Healthy Days—Population Assessment of Health-Related Quality of Life Atlanta, GA: US Centers for Disease Control and Prevention, 2000. www.cdc.gov/hrqol/monograph.htm (16 November 2006, date last accessed).

  8. Mokdad AH, Stroup DF, Giles WH. (2003) Public health surveillance for behavioral risk factors in a changing environment. Recommendations from the Behavioral Risk Factor Surveillance Team. Morb Mortal Wkly Rep Recomm Rep 52: pp. 1–12 www.cdc.gov/mmwr/preview/mmwrhtml/rr5209a1.htm (16 November 2006, date last accessed).

  9. US Office of the Federal Register, National Archives and Records Administration. (1996) Code of Federal Regulations(GPO Access User Support Team, Washington, DC) www.access.gpo.gov/nara/cfr/cfr-table-search.html and www.hhs.gov/ohrp/humansubjects/guidance/45cfr46.htm#46.109 (16 November 2006, date last accessed).

  10. Brown DW, Balluz LS, Ford ES, et al. (2003) Associations between short- and long-term unemployment and frequent mental distress among a national sample of men and women. J Occup Environ Med 45:1159–1166.[CrossRef][Web of Science][Medline]

  11. Kinne S and Topolski TD. (2005) Inclusion of people with disabilities in telephone health surveillance surveys. Am J Public Health 95:512–517.[Abstract/Free Full Text]


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?



This Article
Right arrow Abstract Freely available
Right arrow FREE Full Text (PDF) Freely available
Right arrow All Versions of this Article:
57/3/217    most recent
kql177v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Disclaimer
Google Scholar
Right arrow Articles by Okoro, C.
Right arrow Articles by Mokdad, A.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Okoro, C.
Right arrow Articles by Mokdad, A.
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?