Poverty, unemployment, and common mental disorders: population based cohort study.

OBJECTIVE To determine whether poverty and unemployment increase the likelihood of or delay recovery from common mental disorders, and whether these associations could be explained by subjective financial strain. DESIGN Prospective cohort study. SETTING England, Wales, and Scotland. SUBJECTS 7726 adults aged 16-75 living in private households. MAIN OUTCOME MEASURES Common mental disorders were assessed using the general health questionnaire, a self assessed measure of psychiatric morbidity. RESULTS Poverty and unemployment (odds ratio 1.86, 95% confidence interval 1.18 to 2.94) were associated with the maintenance but not onset of episodes of common mental disorders. Associations between poverty and employment and maintenance of common mental disorders, however, were much smaller than those of cross sectional studies. Financial strain at baseline was independently associated with both onset (1.57, 1.19 to 2.07) and maintenance (1.86, 1.36 to 2.53) even after adjusting for objective indices of standard of living. CONCLUSIONS Poverty and unemployment increased the duration of episodes of common mental disorders but not the likelihood of their onset. Financial strain was a better predictor of future psychiatric morbidity than either of these more objective risk factors though the nature of this risk factor and its relation with poverty and unemployment remain unclear.