Adolescent psychiatric inpatient treatment and subsequent labor market trajectories

BACKGROUND: Adolescent psychiatric disorders are associated with subsequent labor market disadvantage, including unemployment, disability pensions, and not being in education, employment or training (NEET). However, most current research has focused on cross-sectional outcomes measured at single time points, which clouds the dynamics involved in the realization of early labor market careers. METHODS: The study is based on longitudinal register data on all individuals born in Finland in 1980-1984 and residing in the country between ages 10-20 (N = 316,526). We followed the study subjects from age 20 to 34 and used multistate models to model transitions between advantaged and disadvantaged labor market states. Labor market disadvantage was defined as being either unemployed, NEET or on disability pension. We examined differences in labor market trajectories by adolescent psychiatric inpatient episodes, measured using hospital discharge data from ages 10-19. Separate analyses by diagnostic groups were conducted. RESULTS: Individuals who had psychiatric inpatient episodes in adolescence (3%) started their labor market careers in disadvantaged labor market states twice as often as their peers. They were also more likely to transition from advantaged states to disadvantaged states (HR among men: 2.93; 95% CI: 2.85, 3.02) and less likely to experience the opposite transition (HR among men: 0.47; 95% CI: 0.46, 0.48). In total, individuals with a history of psychiatric episodes spent 1.7 to 6.7 more years in disadvantaged states than their peers, depending on sex, baseline state and diagnostic group. The associations were slightly stronger among men than among women. CONCLUSIONS: The results suggest that adolescents with severe mental health problems are highly vulnerable in terms of labor market outcomes throughout their early adulthood. Supportive measures at the start of employment trajectories as well as during later labor market stages are required. KEY MESSAGES: • Psychiatric inpatient episodes in adolescence are associated with labor market disadvantage at the start of work careers and with disadvantageous transitions throughout subsequent trajectories. • To ensure that adolescents facing severe mental health problems are able to realize their full potential, supportive measures at different stages of work careers are required.