Effects of poverty on mental health in the UK working-age population: causal analyses of the UK Household Longitudinal Study

Publication type

Journal Article

Authors

Publication date

April 15, 2023

Summary:

Background:

Addressing poverty through taxation or welfare policies is likely important for public mental health; however, few studies assess poverty’s effects using causal epidemiology. We estimated the effect of poverty on mental health.
Methods:

We used data on working-age adults (25–64 years) from nine waves of the UK Household Longitudinal Survey (2009–19; n = 45 497/observations = 202 207 following multiple imputation). We defined poverty as a household equivalized income <60% median, and the outcome likely common mental disorder (CMD) as a General Health Questionnaire-12 score ≥4. We used double-robust marginal structural modelling with inverse probability of treatment weights to generate absolute and relative effects. Supplementary analyses separated transitions into/out of poverty, and stratified by gender, education, and age. We quantified potential impact through population attributable fractions (PAFs) with bootstrapped standard errors.
Results:

Good balance of confounders was achieved between exposure groups, with 45 830 observations (22.65%) reporting poverty. The absolute effect of poverty on CMD prevalence was 2.15% [%-point change; 95% confidence interval (CI) 1.45, 2.84]; prevalence in those unexposed was 20.59% (95% CI 20.29%, 20.88%), and the odds ratio was 1.17 (95% CI 1.12, 1.24). There was a larger absolute effect for transitions into poverty [2.46% (95% CI 1.56, 3.36)] than transitions out of poverty [–1.49% (95% CI –2.46, –0.53)]. Effects were also slightly larger in women than men [2.34% (95% CI 1.41, 3.26) versus 1.73% (95% CI 0.72, 2.74)]. The PAF for moving into poverty was 6.34% (95% CI 4.23, 8.45).
Conclusions:

PAFs derived from our causal estimates suggest moves into poverty account for just over 6% of the burden of CMD in the UK working-age population, with larger effects in women.

Published in

International Journal of Epidemiology

Volume and page numbers

Volume: 52 , p.512 -522

DOI

https://doi.org/10.1093/ije/dyac226

ISSN

3005771

Subjects

Notes

Open Access

© The Author(s) 2022. Published by Oxford University Press on behalf of the International Epidemiological Association.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.

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