HEALTH AND REEMPLOYMENT IN A 2 YEAR FOLLOW-UP OF LONG-TERM UNEMPLOYED

Study objective-The aim was to examine re-employment and changes in health during a two year follow up of a representative sample of long term unemployed. Design-This was a cross sectional study and a two year follow up. Health was measured by psychometric testing, Hopkins symptom checklist, General health questionnaire, and medical examination. Health related selection to continuous unemployment and recovery by re-employment was estimated by logistic regression with covariances deduced from the labour market theories of human capital and segmented labour market. Setting-Four municipalities in Grenland, southern Norway. Subjects-Participants were a random sample of 17 to 63 year old people registered as unemployed for more than 12 weeks. Main results-In the cross sectional study, the prevalence of depression, anxiety, and somatic illness was from four to 10 times higher than in a control group of employed people. In the follow up study, there was considerable health related selection to reemployment. A psychiatric diagnosis was associated with a 70% reduction in chances of obtaining a job. Normal performance on psychometric testing showed a two to three times increased chance of re-employment. Recovery of health following re-employment was less than expected from previous studies. Conclusions-Health related selection to long term unemployment seems to explain a substantial part of the excess mental morbidity among unemployed people. An increased proportion of the long term unemployed will be vocationally handicapped as years pass, putting a heavy burden on social services.