Study shows that income remains lower for up to 10 years after diagnosis
A diagnosis of depression in connection with hospital treatment can have long-term consequences for personal finances. This is shown in a new registry-based study from the Department of Public Health, University of Southern Denmark, which follows nearly five million people in Denmark over time.
The study found that income is around 10% lower 10 years after diagnosis compared with people without depression, and the gap does not disappear. At the same time, the income loss for depression is greater than for several physical illnesses such as stroke and breast cancer.
Mental illness has the greatest financial impact
The study compares depression, alcohol use disorder, stroke and breast cancer. Income falls after illness in all four groups, but the decline is greatest for mental disorders.
“We see that mental disorders affect not only health, but also people’s economic life course to a considerable extent,” says Emily K. Johnson, PhD Student at the Danish Centre for Health Economics, Department of Public Health, University of Southern Denmark.
She is first author of the study, which has been published in JAMA Health Forum.
“The income loss grows over time and can still be measured 10 years later. Even though mental disorders are more common in women, losses are generally greater for men,” Emily K. Johnson explains.
Not just a temporary loss
While earlier studies have often focused on short-term sick leave, the new study shows that income loss persists and in many cases grows over time.
– It is not only about being away from work for a period. We see changes in the entire income trajectory, says Emily K. Johnson.
This may, among other things, reflect reduced ability to keep a job, change jobs or progress in a career.
May reinforce social inequality
Income loss is greatest among people in the middle of working life, when earnings would normally be increasing. At the same time, the loss grows over time for younger people.
“If you are affected early in your career, you may lose your footing in the labour market. That can be difficult to recover later,” says Emily K. Johnson.
People outside the labour market are also hit particularly hard. For them, illness may make it even harder to enter employment. The findings therefore suggest that illness can reinforce existing social inequality.
Income falls before the illness is registered
Income already begins to decline in the years before people receive a diagnosis of depression in hospital care. This suggests that the consequences begin before the illness is formally registered and treated.
The study includes people who had contact with a hospital, either as inpatients or outpatients, including psychiatric hospital care. People treated only by their general practitioner or by private psychologists or psychiatrists are not included.
“This suggests that the course of illness starts earlier and that the consequences for working life emerge gradually,” Emily K. Johnson explains. Job loss, income loss and poor mental health can reinforce one another over time,
The study is based on Danish registry data and includes all non-retired residents aged 18 to 65 between 2000 and 2018. People with illness were compared with similar people without a diagnosis, matched on factors including age, sex, education and income, and baseline health.
Income was measured as disposable income, meaning post-tax income including wages, transfers and capital income.
Can inform health policy priorities
According to the researchers, the findings can help improve decision-making in health and social policy.
“Priority setting should not be based only on how many people become ill, but also on how illness affects people’s working lives and finances, especially for those early in their careers,” says Emily K. Johnson.
The study adds new knowledge by comparing mental and physical illnesses using the same method, making it possible to assess their relative consequences.
Limitations
The study includes only people who had contact with a hospital and therefore does not cover everyone with depression. At the same time, it cannot establish cause and effect with certainty, especially in the case of mental disorders which are difficult to measure. In addition, only people who survive the course of illness are included in the analyses of income over time.
By Marianne Lie Becker
Source: University of Southern Denmark
