Melbourne School of Population and Global Health - Theses
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ItemWorking it out: A social epidemiological analysis of labour force status, mental health, and disability among young Australians( 2022)Background Young people with disabilities are more likely to have poorer employment and mental health outcomes. However, the relationship between labour force status, mental health, and disability is less understood among young people, despite improvements in employment outcomes representing a feasible way to reduce the mental health inequalities experienced by young people with disabilities. This thesis aims to a) quantify the effect of labour force status on the mental health of young people with disabilities, b) explore which groups of young people with disabilities are most at risk of poorer labour force outcomes and c) identify and appraise existing research exploring how employment conditions and psychosocial workplace exposures impact the mental health of young people when they are in employment. Methods Four of five studies in this thesis used nationally representative Australian data sources. Studies I and II used effect measure modification to assess whether disability status modified the association between labour force status and mental health. The third study used causal mediation analysis to quantify the total causal effect of disability status on the mental health of young adults, and then determine the amount of the effect that operates through employment status. Study IV used group-based trajectory modelling and multinomial logistic regression to identify patterns of disability throughout early life and associations with labour force outcomes as a young adult. The fifth study used systematic review methods to ascertain existing knowledge regarding the associations between employment conditions and psychosocial workplace exposures and mental health among young people. Results Studies I and II indicated unemployment is associated with poorer mental health among young people, with Study II additionally finding that disability status modified the employment status-to-psychological distress relationship such that young people with disabilities who were unemployed had significantly higher levels of distress. Expanding on these results, Study III revealed that two consecutive years of reporting a disability led to a clinically significant decline in mental health, with part of this decline operating through employment status. Trajectory modelling in Study IV identified four distinct patterns of disability status, and regression modelling suggested individuals in the low-increasing trajectory were at increased risk of unemployment in early adulthood, while individuals with a consistently high prevalence of disability were at increased risk of being not in the labour force. Studies identified in the systematic review were limited in scope and quality, precluding a focus on young people with disabilities and highlighting a need for higher quality research. Conclusion These findings indicate that improving employment outcomes among young people with disabilities would likely contribute to reductions in the mental health inequalities experienced by this group. Improving existing programs, supports, and other interventions to help secure employment for young people with disabilities who want to work is a feasible way to improve the mental health of this group. However, further research must clarify how employment conditions and psychosocial workplace exposures are associated with mental health outcomes to ensure that employment for young people with disabilities optimizes mental health outcomes.