Differential employment quality and educational inequities in mental health: A causal mediation analysis

Details

• Alternative Title:
  Epidemiology
• Personal Author:
  Blaikie, Kieran ; Eisenberg-Guyot, Jerzy ; Andrea, Sarah B ; Owens, Shanise ; Minh, Anita ; Keil, Alexander P ; Hajat, Anjum
• Description:
  Background
  
  In the United States inequities in mental distress between those more and less educated have widened over recent years. Employment Quality, a multidimensional construct reflecting the relational and contractual features of employer–employee relationships, may mediate this inequity throughout adulthood, yet no study has examined the extent of this mediation in the United States, or how it varies across racialized and gendered populations.
  
  Methods
  
  Using information on working-age adults from the 2001-2019 Panel Study of Income Dynamics, we construct a composite measure of employment quality via principal component analysis. Using this measure and the parametric mediational g-formula, we then estimate randomized interventional analogues for natural direct and indirect effects of low baseline educational attainment (≤High School: No/Yes) on end-of-follow-up prevalence of moderate mental distress (Kessler-6 Score ≥5: No/Yes) overall and within subgroups by race and gender.
  
  Results
  
  We estimate that low educational attainment would result in a 5.3% greater absolute prevalence of moderate mental distress at end of follow-up (randomized total effect: 5.3%, 95% CI: 2.2%, 8.4%), with approximately 32% of this effect mediated by differences in employment quality (indirect effect: 1.7%, 95% CI: 1.0%, 2.5%). The results of subgroup analyses across race and gender are consistent with the hypothesis of mediation by employment quality, though not when selecting on full employment (indirect effect: 0.6%, 95% CI: −1.0%, 2.6%).
  
  Conclusions
  
  We estimate that approximately one third of US educational inequities in mental distress may be mediated by differences in employment quality.
  
  
• Subjects:
  Adult Educational Status Employment Humans Mediation Analysis Mental Disorders Mental Health United States
• Keywords:
  Education Employment Quality G-formula Health Disparities Mediation Analysis Mental Health
• Source:
  Epidemiology. 34(5):747-758
• Pubmed ID:
  37195284
• Pubmed Central ID:
  PMC10524205
• Document Type:
  Journal Article
• Funding:
  P30 ES007033/ES/NIEHS NIH HHSUnited States/ ; R01 AG060011/AG/NIA NIH HHSUnited States/ ; T32 MH013043/MH/NIMH NIH HHSUnited States/ ; T42 OH008433/OH/NIOSH CDC HHSUnited States/
• Volume:
  34
• Issue:
  5
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:7fe7514ce8716541ed933e0b7d9f3d4ba5fa311cea0018a3d0c4fee5afcc18420c0e8931a5ce676eb9504c2931d7fa1c4f1b173bf6e79a7b4cfccd0077fdfe86
• Download URL:
  https://stacks.cdc.gov/view/cdc/133481/cdc_133481_DS1.pdf
• File Type:
  [PDF - 472.86 KB ]