Population Health

At a Glance Projects Publications Team


Social and Economic Determinants of Mental and Cognitive Health

Maarten Jacob Bijlsma, Karen van Hedel, Kieron Barclay, Peng Li, Yaoyue Hu, Pekka Martikainen (MPIDR / University of Helsinki, Finland)

Detailed Description

Depression is a leading contributor to the global burden of disease, with a lifetime prevalence of 10 to 15% worldwide. The effects of depression extend far beyond its direct symptoms to a greatly increased risk of suicide and, possibly, of cardiac death. Employment, income, and depression are interrelated. Various methodological problems must be overcome when seeking to disentangle the relationship between these three factors. Even when using rich Scandinavian register data, one problem of particular concern are unmeasured forces that affect both depression and its potential causes: unmeasured confounding. One technique that has proven to be highly effective in dealing with this problem is the use of individual-level fixed-effect intercepts. This technique allowed us to leverage the rich longitudinal structure of the data while filtering out time-stable unobserved confounding, bringing our estimates closer to causal effects.

To investigate the relationship between psychotropic drug use and income, we used longitudinal register-based data comprising a nationally representative random sample of Finnish residents aged 30-–62 between 2003 and 2013. Following adjustment for an extensive set of confounders, no contemporaneous association between variations in annual individual income and psychotropic drug purchasing was observed. Similar results were obtained irrespective of baseline income level and sex. The results imply that indirect selection based on preexisting individual characteristics plays a major role in explaining the association between variations in income measured over the short term and psychotropic drug purchases. The association appears largely attributable to unobserved, stable individual characteristics.

Parental unemployment is associated with worse adolescent mental health, but prior evidence has primarily been based on cross-sectional studies subject to reverse causality and confounding. We assessed the association between parental unemployment and changes in adolescent psychotropic medication purchases with longitudinal individual-level fixed-effects models that controlled for time-stable confounding. We used data from a large, register-based panel of Finnish adolescents aged 13–20 in 1987–2012 (n = 138,644), these included annual measurements of mothers’ and fathers’ employment and offspring psychotropic medication purchases. We assessed changes in the probability of adolescent psychotropic medication purchases in the years before, during, and after the first episode of parental unemployment. Our results have shown that there was no association between mother’s unemployment and offspring psychotropic purchases in the fixed-effects models, suggesting that this association is largely driven by unmeasured confounding and selection. By contrast, father’s unemployment led to a significant 15–20% increase in the probability of purchasing psychotropic medication among adolescents even after extensive controls for observed and unobserved confounding. This change takes at least one year to emerge, but it is long-lasting; thus, policies are needed that mitigate the harm of father’s unemployment on offspring’s mental well-being.

Research Keywords:

Economics, Employment, Retirement, Family Behavior, Health Care, Public Health, Medicine, and Epidemiology, Life Course, Psychology

Region keywords:

China, Europe, Finland


Pitkänen, J.; Bijlsma, M. J.; Remes, H.; Aaltonen, M.; Martikainen, P.:
Social Science and Medicine - Population Health 13:100756, 1–9. (2021)    
Junna, L. M.; Moustgaard, H.; Tarkiainen, L.; Martikainen, P.:
Epidemiology 30:2, 221–229. (2019)
Moustgaard, H.; Avendano , M.; Martikainen, P.:
American Journal of Epidemiology 187:9, 1880–1888. (2018)    
Rostila, M.; Mäki, N.; Martikainen, P.:
PLoS One 13:5, e0195500–e0195500. (2018)    
van Hedel, K.; Martikainen, P.; Moustgaard, H.; Myrskylä, M.:
SSM-Population Health 4, 244–253. (2018)    
Bijlsma, M. J.; Tarkiainen, L.; Myrskylä, M.; Martikainen, P.:
Social Science and Medicine 194, 142–150. (2017)    
Korhonen, K.; Remes, H.; Martikainen, P.:
Social Psychiatry and Psychiatric Epidemiology 52:1, 105–116. (2017)
Moustgaard, H.; Joutsenniemi, K.; Martikainen, P.:
European Journal of Public Health 26:6, 1034–1039. (2016)
The Max Planck Institute for Demographic Research (MPIDR) in Rostock is one of the leading demographic research centers in the world. It's part of the Max Planck Society, the internationally renowned German research society.