Identifying the mechanisms for workplace burden of psychiatric illness.

BACKGROUND Although previous research indicates that mental disorders detract from labor market outcomes, little is known about which psychiatric symptoms are most important. OBJECTIVE The objective of this study was to identify the mechanisms, or most important symptoms, through which psychiatric disorders affect labor market outcomes. We focus on major depressive episode, panic attack, social phobia, and generalized anxiety disorder. Our approach builds on prior work in that we consider the effects of symptoms both among individuals meeting and among individuals not meeting the diagnostic criteria for mental disorders. RESEARCH DESIGN Data were obtained from the National Comorbidity Survey Replication and the National Latino and Asian American Study. We used a structural equation model with latent indices for mental disorders, where the indices are generated from the model using multiple indicators (symptoms) and multiple causes of the disorders. MEASURES The outcomes were current employment/labor force participation, weeks worked in last year, and number of work absences in the last month among employed individuals. RESULTS We found that for major depressive episode, symptoms of insomnia/hypersomnia, indecisiveness, severe emotional distress, and fatigue are crucial for labor market outcomes. In the case of generalized anxiety disorder, the length of the episode, symptoms relating to difficulty controlling worry, and symptoms of worry/anxiety/nervousness causing significant emotional distress were most detrimental for work outcomes. Social phobia and panic attack were not associated with labor market outcomes. CONCLUSION Our findings suggest that interventions targeting these particular symptoms may be most helpful in improving work functioning.