The rate of any current employment among adults aged 18 to 64 who experienced major depressive episode (MDE) in the past year was lower in 2007 (63.2 percent) than in either 2004 (68.8 percent) or 2006 (66.9 percent)
In each year from 2004 to 2007, the rate of full-time employment was lower among those with MDE than among those without MDE
Combined data from 2004 to 2007 indicate that the difference in the rate of any current employment between those with and without MDE was especially high for males, adults aged 26 or older, those who lived in non-metropolitan counties, and those who had received government assistance in the past year
The inability to find and maintain meaningful employment is a major issue for individuals who experience mental disorders.1,2 Barriers to employment among those with mental disorders include lack of confidence, fear and anxiety, gaps in work history, social stigma, and workplace discrimination and inflexibility.3 The co-occurrence of mental disorders and unemployment can be a cycle in which a person's mental condition can make it difficult to get or maintain employment, and the strain of unemployment can worsen a person's mental condition. As a result, there is a need for additional services, such as supported employment programs, for those with mental disorders.4
The National Survey on Drug Use and Health (NSDUH) includes questions about current employment (full time or part time), as well as about major depressive disorder (MDE). NSDUH defines "full-time employment" as usually working 35 or more hours per week and either working in the past week or having a job despite not working in the past week. "Part-time employment" is defined as usually working fewer than 35 hours per week and either working in the past week or having a job despite not working in the past week. "Any current employment" includes working either full or part time in the week prior to the interview. "MDE" refers to a period of 2 weeks or longer during which there is either depressed mood or loss of interest or pleasure, as well as other symptoms.5
This issue of The NSDUH Report examines employment rates among adults aged 18 to 64 by MDE. The first section presents information on trends in the employment rates for those with or without MDE from 2004 to 2007. The remaining sections present differences in the employment rates for those with or without MDE by demographic and geographic characteristics, using annual averages based on combined 2004 to 2007 data.
Trends in Employment Rates, by MDE
From 2004 to 2007, the rate of any current employment was lower in 2007 (63.2 percent) than in either 2004 (68.8 percent) or 2006 (66.9 percent) among adults aged 18 to 64 with MDE; this pattern was similar for full-time employment (i.e., a lower rate in 2007 compared with 2004 or 2006) (Table 1). From 2004 to 2007, there were no statistically significant differences in the rates of part-time employment among those with MDE and among those without MDE.
Table 1. Current Employment Status among Adults Aged 18 to 64 with or without Major Depressive Episode (MDE)*: 2004 to 2007
* MDE is defined using the diagnostic criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which specifies a period of 2 weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image. In assessing MDE, no exclusions were made for MDE caused by medical illness, bereavement, or substance use disorders. See the American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
** Difference between estimate and estimate for 2007 is statistically significant at p < .05.
Source: 2004 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).
In each year from 2004 to 2007, the rates of any current employment and full-time employment were lower for adults aged 18 to 64 with MDE compared with those without MDE. In each year, those with or without MDE had a similar rate of part-time employment.
Employment Status, by MDE and Demographic Characteristics
Combined data from 2004 to 2007 indicate that the rate of any current employment was lower among adults aged 18 to 64 with MDE than among those without MDE for both genders (Figure 1).6 However, there was less of a difference in the rate of any current employment by MDE for females than for males. Within each age group (18 to 25, 26 to 49, and 50 to 64), the rate of any current employment was lower for those with MDE than for those without MDE. However, there was less of a difference in the current employment rate by MDE for those aged 18 to 25 than for those aged 26 to 49 and those aged 50 to 64.
Figure 1. Any Current Employment among Adults Aged 18 to 64, by Major Depressive Episode (MDE)* and Demographic Characteristics: 2004 to 2007
Figure 1 Table. Any Current Employment among Adults Aged 18 to 64, by Major Depressive Episode (MDE)* and Demographic Characteristics: 2004 to 2007
Age Group and Gender
Had MDE
Did Not Have MDE
18 to 25
70.4%
73.1%
26 to 49
69.7%
83.9%
50 to 64
54.2%
72.3%
Male
67.5%
84.8%
Female
65.4%
72.6%
* MDE is defined using the diagnostic criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which specifies a period of 2 weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image. In assessing MDE, no exclusions were made for MDE caused by medical illness, bereavement, or substance use disorders. See the American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Source: 2004 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).
The smaller impact of MDE on the employment of females compared with males and on those aged 18 to 25 compared with older age groups may be partially explained by the relatively high rate of part-time employment among those groups. The rate of part-time employment was higher for females than for males (18.2 vs. 8.8 percent) and was higher for those aged 18 to 25 than for those aged 26 to 49 or those aged 50 to 64 (25.4 vs. 10.6 and 11.8 percent, respectively).
Employment Status, by MDE and Geographic Characteristics
Combined data from 2004 to 2007 indicate that, within each region of the United States, the rate of any current employment was lower among adults aged 18 to 64 with MDE than among those without MDE (Figure 2). In both metropolitan and non-metropolitan counties, the rate of any current employment was lower among those with MDE than among those without MDE. However, there was less of a difference in the rate of current employment by MDE for those in metropolitan counties than for those in non-metropolitan counties.
Figure 2. Any Current Employment among Adults Aged 18 to 64, by Major Depressive Episode (MDE)* and Geographic Characteristics: 2004 to 2007
Figure 2 Table. Any Current Employment among Adults Aged 18 to 64, by Major Depressive Episode (MDE)* and Geographic Characteristics: 2004 to 2007
Region and County Type
Had MDE
Did Not Have MDE
Northeast
68.4%
79.5%
Midwest
67.5%
80.3%
South
63.2%
77.7%
West
67.6%
78.4%
Metropolitan
68.0%
79.3%
Non-Metropolitan
57.9%
76.0%
* MDE is defined using the diagnostic criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which specifies a period of 2 weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image. In assessing MDE, no exclusions were made for MDE caused by medical illness, bereavement, or substance use disorders. See the American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Source: 2004 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).
Employment Status, by MDE and Receipt of Government Assistance
Combined data from 2004 to 2007 indicate that adults aged 18 to 64 with MDE had a lower rate of any current employment compared with their counterparts who did not have MDE, regardless of whether they had received government assistance in the past year (Figure 3).7 However, there was more of a difference in the rate of current employment by MDE for those who had received government assistance in the past year than for those who did not. Among those who received government assistance, the rate of any current employment was 40.6 percent for those with MDE.
Figure 3. Any Current Employment among Adults Aged 18 to 64, by Major Depressive Episode (MDE)* and Receipt of Government Assistance**: 2004 to 2007
Figure 3 Table. Any Current Employment among Adults Aged 18 to 64, by Major Depressive Episode (MDE)* and Receipt of Government Assistance**: 2004 to 2007
Receipt of Government Assistance
Had MDE
Did Not Have MDE
Received Government Assistance
40.6%
57.8%
Did Not Receive Government Assistance
74.4%
82.1%
* MDE is defined using the diagnostic criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which specifies a period of 2 weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image. In assessing MDE, no exclusions were made for MDE caused by medical illness, bereavement, or substance use disorders. See the American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
** Government assistance is defined as one or more household family members having received Supplemental Security Income (SSI), cash assistance (Temporary Assistance for Needy Families; TANF), noncash assistance, or food stamps.
Source: 2004 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).
Employment Status, by MDE and Substance Dependence or Abuse
Adults aged 18 to 64 with MDE had a lower rate of any current employment compared with those who did not have MDE, regardless of whether they had substance abuse or dependence in the past year (Figure 4).8 Additionally, the rate of any current employment was higher for those with substance dependence or abuse than for those without substance dependence or abuse, regardless of whether they had MDE.
Figure 4. Any Current Employment among Adults Aged 18 to 64, by Major Depressive Episode (MDE)* and Substance Dependence or Abuse**: 2004 to 2007
Figure 4 Table. Any Current Employment among Adults Aged 18 to 64, by Major Depressive Episode (MDE)* and Substance Dependence or Abuse**: 2004 to 2007
Substance Dependence or Abuse
Had MDE
Did Not Have MDE
Had Substance Dependence or Abuse
69.5%
80.1%
Did Not Have Substance Dependence or Abuse
65.1%
78.6%
* MDE is defined using the diagnostic criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which specifies a period of 2 weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image. In assessing MDE, no exclusions were made for MDE caused by medical illness, bereavement, or substance use disorders. See the American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
** Dependence on or abuse of alcohol or illicit drugs is defined using criteria specified in the DSM-IV. Substance dependence or abuse includes such symptoms as withdrawal, tolerance, use in dangerous situations, trouble with the law, and interference in major obligations at work, school, or home during the past year. See the American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.
Source: 2004 to 2007 SAMHSA National Surveys on Drug Use and Health (NSDUHs).
Discussion
These data indicate that, from 2004 to 2007, adults aged 18 to 64 with MDE were less likely to be employed overall and less likely to be employed full time than those without MDE. This suggests that those who experience MDE may need additional services and support to find and maintain full-time employment and to transition from part-time to full-time work. These data also indicate that the difference in the overall employment rate between those who experienced MDE and those who did not was more marked for certain subgroups, including males, those aged 26 or older, those living in non-metropolitan areas, and those who received government assistance. The findings suggest that a concentration of employment services for persons from these subgroups who have experienced MDE may be an effective method of increasing the overall employment rate among those who have experienced this condition.
End Notes1 Stuart, H. (2006). Mental illness and employment discrimination. Current Opinion in Psychiatry, 19, 522-526. 2 Substance Abuse and Mental Health Services Administration. (2002, December). High unemployment and disability for people with serious mental illness. In Interim report of the President's New Freedom Commission on Mental Health (NMH02-0144). Rockville, MD: Author. [Available at http://mentalhealth.samhsa.gov/publications/allpubs/NMH02-0144/default.asp] 3 Canadian Mental Health Association. (2009). Employment and mental illness. Retrieved July 13, 2009, from http://www.cmha.ca/BINS/content_page.asp?cid=3-109 4 Clay, R. A. (2006, May/June). Employment: Help for people with mental illnesses. SAMHSA News, 14(3), 1-5. [Available at http://www.samhsa.gov/samhsa_news/VolumeXIV_3/index.htm] 5 MDE is defined using the diagnostic criteria in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which specifies a period of 2 weeks or longer during which there is either depressed mood or loss of interest or pleasure and at least four other symptoms that reflect a change in functioning, such as problems with sleep, eating, energy, concentration, and self-image. In assessing MDE, no exclusions were made for MDE caused by medical illness, bereavement, or substance use disorders. See the American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author. 6 Based on combined 2004 to 2007 data, 8.5 percent of adults aged 18 to 24 were classified as having experienced MDE. 7 Government assistance is defined as one or more household family members having received Supplemental Security Income (SSI), cash assistance (Temporary Assistance for Needy Families; TANF), noncash assistance, or food stamps. 8 Dependence on or abuse of alcohol or illicit drugs is defined using criteria specified in the DSM-IV. Substance dependence or abuse includes such symptoms as withdrawal, tolerance, use in dangerous situations, trouble with the law, and interference in major obligations at work, school, or home during the past year.
Suggested CitationSubstance Abuse and Mental Health Services Administration, Office of Applied Studies. (August 6, 2009). The NSDUH Report: Employment and Major Depressive Episode. Rockville, MD.
The National Survey on Drug Use and Health (NSDUH) is an annual survey sponsored by the Substance Abuse and Mental Health Services Administration (SAMHSA). The 2004 to 2007 combined data are based on information obtained from 150,220 persons aged 18 to 64. The survey collects data by administering questionnaires to a representative sample of the population through face-to-face interviews at their place of residence.
The NSDUH Report is prepared by the Office of Applied Studies (OAS), SAMHSA, and by RTI International in Research Triangle Park, North Carolina. (RTI International is a trade name of Research Triangle Institute.)
Information on the most recent NSDUH is available in the following publication:
Office of Applied Studies. (2008). Results from the 2007 National Survey on Drug Use and Health: National findings (DHHS Publication No. SMA 08-4343, NSDUH Series H-34). Rockville, MD: Substance Abuse and Mental Health Services Administration. Also available online: http://oas.samhsa.gov.
The NSDUH Report is published periodically by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Office of Applied Studies are available online: http://oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.
