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Mental Health Problems at a Critical Juncture: Exit from Social Assistance among Young Finns

Published online by Cambridge University Press:  23 September 2020

MARIA VAALAVUO Open the ORCID record for MARIA VAALAVUO [Opens in a new window]  and
BORIS BAKKUM
MARIA VAALAVUO
Affiliation:
Finnish Institute for Health and Welfare, Centre for Health and Social Economics, Mannerheimintie 166, 00271Helsinki, Finland. Email: [email protected]
BORIS BAKKUM
Affiliation:
Finnish Institute for Health and Welfare, Centre for Health and Social Economics. Email: [email protected]
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Abstract

Reducing social assistance dependency is high on the political agenda; labour market and social exclusion of youth, in particular, has been considered worrisome. With these policy objectives and societal considerations in mind we set to study the association between health problems, with a specific focus on mental health, and the duration of social assistance receipt among young adults in Finland. Our analyses are based on rich register data encompassing the total population in the metropolitan area of Finland from 2005 to 2016. We follow a cohort of new social assistance recipients (n=36,728) aged 18–34 for a maximum of 60 months using Cox proportional hazard model. The results show a strong association between mental health problems and duration of social assistance receipt. The association was the strongest among those aged 18–24. Some differences in the strength of the association were found for different psychiatric diagnoses. On the other hand, somatic diagnoses were only weakly associated with duration of social assistance receipt. Mental health problems appear to be an important obstacle for exiting social assistance and this should be taken into account when governments aim to decrease welfare dependency and reform the last-resort financial aid.

Keywords

Cox proportional hazard modelduration analysishealth selectionmental healthregister datasocial assistanceyoung adults
Type
Article
Information
Journal of Social Policy , Volume 50 , Issue 4 , October 2021 , pp. 764 - 787
Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Allen, J., Balfour, R., Bell, R. and Marmot, M. (2014), Social determinants of mental health. International Review of Psychiatry, 26(4), 392-407.CrossRefGoogle ScholarPubMed
Ananth, K. (2012), Managing chronic pain: consider psychotropics and other non-opioids. Current Psychiatry, 11(2), 38-43.Google Scholar
Aneshensel, C.S. (2009), Toward explaining mental health disparities. Journal of Health and Social Behavior, 50, 377-394.CrossRefGoogle ScholarPubMed
Asplund, R. and Vanhala, P. (2013), Nuorten työllisyydestä ja työttömyydestä hyvin vaihteleva kuva. ETLA muistio 19. [in Finnish] http://pub.etla.fi/ETLA-Muistio-Brief-19.pdf Google Scholar
Ayala, L. and Rodriguez, M. (2007), What determines exit from social assistance in Spain? International Journal of Social Welfare, 16, 168-182.CrossRefGoogle Scholar
Bäckman, O. and Bergmark, Å. (2011), Escaping welfare? Social assistance dynamics in Sweden. Journal of European Social Policy, 21(5), 486-500.Google Scholar
Baggio, S., Iglesias, K., Deline, S., Studer, J., Henchoz, Y., Mohler-Kuo, M. and Gmel, G. (2015), Not in education, employment, or training status among young Swiss men. Longitudinal associations with mental health and substance use. Journal of Adolescent Health, 56(2), 238-243.CrossRefGoogle ScholarPubMed
Bago d’Uva, T., O’Donnell, O. and van Doorslaer, E. (2008), Differential health reporting by educational level and its impact on the measurement of health inequalities among older Europeans. International Journal of Epidemiology, 37(6), 1375-1383.CrossRefGoogle Scholar
Baigi, A., Lindgren, E.C., Starrin, B. and Bergh, H. (2008), In the shadow of the welfare society ill-health and symptoms, psychological exposure and lifestyle habits among social security recipients: a national survey study. Biopsychosocial Medicine, 2(15).CrossRefGoogle ScholarPubMed
Baldwin, M.L. and Marcus, S.C. (2011), Stigma, Discrimination, and Employment Outcomes among Persons with Mental Health Disabilities. In Schultz, I.Z., Rogers, E.S. (eds.) Work Accommodation and Retention in Mental Health. New York: Springer.Google Scholar
Benjamins, M.R., Hummer, R.A., Eberstein, I.W. and Nam, C.B. (2004), Self-reported health and adult mortality risk: an analysis of cause-specific mortality. Social Science & Medicine, 59 (6), 1297−306.CrossRefGoogle ScholarPubMed
Bergmark, Å. and Bäckman, O. (2011), Stuck with Welfare? Long-term Social Assistance Recipiency in Sweden. European Sociological Review, 20(5), 425-443.CrossRefGoogle Scholar
Case, A., Lubotsky, D. and Paxson, C. (2002), Economic Status and Health in Childhood: The Origins of the Gradient. American Economic Review, 92(5), 1308-1334.CrossRefGoogle ScholarPubMed
Cleves, M., Gould, W.W. and Marchenko, V. (2016), An Introduction to Survival Analysis Using Stata, Revised Third Edition. Stata Press.Google Scholar
Dahl, E. and Lorenzen, T. (2003), Explaining exit to work among social assistance recipients in Norway: heterogeneity or dependency? European Sociological Review, 19(5): 519-536.CrossRefGoogle Scholar
Davis, O. (2019), What is the relationship between benefit conditionality and mental health? Evidence from the United States on TANF policies. Journal of Social Policy, 48(2), 249-269.CrossRefGoogle Scholar
Dohrenwend, B.P., Leav, I., Shrout, P.E., Scwartz, S., Naveh, G., Link, B.G., Skodol, A.E. and Stueve, A. (1992), Socioeconomic status and psychiatric disorders: the causation-selection issue. Science, 21(255), 946-952.CrossRefGoogle Scholar
Fletcher, J. (2013), Adolescent Depression and Adult Labor Market Outcomes. Southern Economic Journal, 80(1), 26-49.CrossRefGoogle Scholar
Goldman, N. (2001), Social inequalities in health. Disentangling the underlying mechanisms. Annals of the New York Academy of Sciences, 954(1), 118-139.CrossRefGoogle ScholarPubMed
Government program (2019), Programme of Prime Minister Sanna Marin’s Government 10 December 2019. Inclusive and competent Finland - a socially, economically and ecologically sustainable society. Online: http://urn.fi/URN:ISBN:978-952-287-811-3 Google Scholar
Grover, C. and Piggott, L. (eds.) (2015), Disabled people, work and welfare. Is employment really the answer? Bristol: Policy Press.CrossRefGoogle Scholar
Haas, S.A. (2006), Health selection and the process of social stratification: the effect of childhood health on socioeconomic attainment. Journal of Health and Social Behavior, 47, 339-354.CrossRefGoogle ScholarPubMed
Haas, S.A., Glymour, M. M. and Berkman, L. F. (2011), Childhood Health and Labor Market Inequality over the Life Course. Journal of Health and Social Behavior, 52(3), 298–313.CrossRefGoogle ScholarPubMed
Hakulinen, C., Elovainio, M., Arffman, M., Lumme, S., Pirkola, S., Manderbacka, K., Keskimäki, I. and Böckerman, P. (2019), Mental disorders and long-term labour market outcomes: nationwide cohort study of 2 055 720 individuals. Acta Psychiatria Scandinavica, 140(4), 371-381.CrossRefGoogle ScholarPubMed
Hammer, T. and Hyggen, C. (2010), Lost in transition? Substance abuse and risk of labour market exclusion from youth to adulthood. Norsk Epidemiologi, 20(1), 93-100.Google Scholar
Helgesson, M., Tinghög, P., Niederkrotenhaler, T., Saboonchi, F. and Mittendorfer-Rutz, E. (2017), Labour-market marginalisation after mental disorders among young natives and immigrants living in Sweden. BMC Public Health, 17(593).CrossRefGoogle ScholarPubMed
Helms Jørgensen, C., Järvinen, T., and Lundahl, L. (2019), A Nordic transition regime? Policies for school-to-work transitions in Sweden, Denmark and Finland. European Educational Research Journal, 18(3), 278–297.Google Scholar
Hoffmann, R., Kröger, H. and Geyer, S. (2019), Social Causation Versus Health Selection in the Life Course: Does Their Relative Importance Differ by Dimension of SES? Social Indicators Research, 141(3), 1341-1368.CrossRefGoogle Scholar
Hoffmann, R., Kröger, H. and Pakpahan, E. (2018), Pathways between socioeconomic status and health: does health selection or social causation dominate in Europe? Advances in Life Course Research, 36, 23-36.CrossRefGoogle Scholar
Hohmeyer, K. and Lietzmann, T. (2020), Persistence of welfare receipt and unemployment in Germany: determinants and duration dependence. Journal of Social Policy, 49(2), 299-322.CrossRefGoogle Scholar
Hu, Y., van Lenthe, F. J., Borsboom, G. J., Looman, C. W. N., Bopp, M., Burström, B., Dzúrová, D., Ekholm, O., Klumbiene, J., Lahelma, E., Leinsalu, M., Regidor, E., Santana, P., de Gelder, R. and Mackenbach, J.P. (2016), Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010. Journal of Epidemiology and Community Health, 70, 644-652.CrossRefGoogle ScholarPubMed
Hudson, C.G. (2005), Socioeconomic Status and Mental Illness: Tests of the Social Causation and Selection Hypotheses. American Journal of Orthopsychiatry, 75(1), 3-18.CrossRefGoogle ScholarPubMed
Hultqvist, S. and Nørup, I. (2017), Consequences of activation policy targeting young adults with health-related problems in Sweden and Denmark. Journal of Poverty and Social Justice, 25(2), 147-161.CrossRefGoogle Scholar
Idler, E.L. and Benyamini, Y. (1997), Self-rated health and mortality: a review of twenty-seven community studies. Journal of Health and Social Behavior, 38 (1), 27−37.CrossRefGoogle ScholarPubMed
Ilmakunnas, I. (2018), Risk and vulnerability in social assistance receipt of young adults in Finland. International Journal of Social Welfare, 27, 5-16.CrossRefGoogle Scholar
Ilmakunnas, I. and Moisio, P. (2018), Social assistance trajectories among young adults in Finland: What are the determinants of welfare dependency. Social Policy and Administration, 53(5), 693-708.CrossRefGoogle Scholar
Jokela, M., Kivipelto, M. and Ylikännö, M. (2019), From social assistance to a social work client [in Finnish “Toimeentulotuelta sosiaalityön asiakkaaksi”]. Working paper 26/2019. Helsinki: Finnish Institute for Health and Welfare.Google Scholar
Kane, J.B., Harris, K.M., Morgan, S.P. and Guilkey, D.K. (2018), Pathways of health and human capital from adolescence into young adulthood. Social Forces, 96(3), 949-976.CrossRefGoogle Scholar
Kaplan, G.A., Siefert, K., Ranjit, N., Raghunathan, T. E., Young, E.A., Tran, D., Danziger, S., Hudson, S., Lynch, J. W. and Tolman, R. (2005), The Health of Poor Women Under Welfare Reform. American Journal of Public Health, 95, 1252-1259.CrossRefGoogle ScholarPubMed
Kauppinen, T., Angelin, A., Lorenzen, T., Bäckman, O., Salonen, T., Moisio, P. and Dahl, E. (2014), Social background and life-course risks as determinants of social assistance receipt among young adults in Sweden, Norway and Finland. Journal of European Social Policy, 24(3), 273-288.CrossRefGoogle Scholar
Kiely, K.M. and Butterworth, P. (2014), Mental health selection and income support dynamics: multiple spell discrete-time survival analyses of welfare receipt. Journal of Epidemiology and Community Health, 68, 349-355.CrossRefGoogle ScholarPubMed
Königs, S. (2013), The Dynamics of Social Assistance Benefit Receipt in Germany: State Dependence Before and After the Harz Reforms. OECD social, Employment and Migration Working Papers No. 136. Paris: OECD.Google Scholar
Kröger, H., Pakpahan, E. and Hoffmann, R. (2015), What causes health inequality? A systematic review on the relative importance of social causation and health selection. European Journal of Public Health, 25(6), 951-960.CrossRefGoogle ScholarPubMed
Lahelma, E., Pietiläinen, O., Pentala-Nikulainen, O., Helakorpi, S. and Rahkonen, O. (2019), 36-year trends in educational inequalities in self-rated health among Finnish adults. SSM – Population Health, 9 (2019).CrossRefGoogle ScholarPubMed
Lorenzen, T., Dahl, E. and Harslof, I. (2012), Welfare risks in early adulthood: A longitudinal analysis of social assistance transitions in Norway. International Journal of Social, 21, 408-421.Google Scholar
Lorenzen, T., Angelin, A., Dahl, E., Kauppinen, T., Moisio, P. and Salonen, T. (2014), Unemployment and economic security for young adults in Finland, Norway and Sweden: from unemployment protection to poverty relief. International Journal of Social Welfare, 23, 41-51.CrossRefGoogle Scholar
Løyland, B., Miaskowski, C., Dahl, E., Paul, S.M. and Rustoen, T. (2011), Psychological distress and quality of life in long-term social assistance recipients compared to the Norwegian population. Scandinavian Journal of Public Health, 39, 303-311.CrossRefGoogle ScholarPubMed
Lundborg, P., Nilsson, A. and Rooth, D.O. (2014), Adolescent health and adult labor market outcomes. Journal of Health Economics, 37, 25-40.CrossRefGoogle ScholarPubMed
Mackenbach, J.P., Stirbu, I., Roskam, A. J. R., Schaap, M. M., Menvielle, G., Leinsalu, M., Kunst, A. E., van Oyen, H., Demarest, S., Rychtarikova, J., Dzurova, D., Andersen, O., Ekholm, O., Judge, K., Tekkel, M., Prättäla, R., Martikainen, P., Desplanques, G., Jusot, F., Helmert, U., Kovacs, K., Marton, F., Layte, R., Costa, G., Vannoni, F., Villerusa, A., Kalediene, R., Klumbiene, J., Geurts, J. J., Dahl, M. E., Strand, B. H., Wojtyniak, B., Santana, P., Madarasova Geckova, A., Artnik, B., Borrell, C., Esnaola, S., Regidor, E., Burström, B., Fritzell, J., Lundberg, O., Bopp, M. and Glickman, M. (2008), Socioeconomic inequalities in health in 22 European countries. New England Journal of Medicine, 358, 2468-2481.CrossRefGoogle ScholarPubMed
Marmot, M. (2005), Social determinants of health inequalities. Lancet, 365, 1099-1104.CrossRefGoogle ScholarPubMed
Mattila-Holappa, P. (2018), Mental health and labour market participation among young adults. Helsinki: The Social Insurance Institution of Finland. Studies in social security and health 152.Google Scholar
Mehta, N., Kassam, A., Leese, M., Butler, G. and Thornicroft, G. (2009), Public attitudes towards people with mental illness in England and Scotland, 1994-2003. The British Journal of Psychiatry, 194, 278-284.CrossRefGoogle Scholar
Metzler, M., Merrick, M.T., Klevens, J., Ports, K.A. and Ford, D.C. (2017), Adverse childhood experiences and life opportunities: shifting the narrative. Children and Youth Services Review, 72, 141-149.CrossRefGoogle Scholar
Miech, R.A., Caspi, A., Moffitt, T.E., Entner Wright, B.R. and Silva, P.A. (1999), Low socioeconomic status and mental disorders: a longitudinal study of selection and causation during young adulthood. American Journal of Sociology, 104(4), 1096-1131.CrossRefGoogle Scholar
Miilunpalo, S., Vuori, I., Oja, P., Pasanen, M. and Urponen, H. (1997), Self-rated health status as a health measure: the predictive value of self-reported health status on the use of physician services and on mortality in the working-age population. Journal of Clinical Epidemiology, 50(5), 517−528.CrossRefGoogle ScholarPubMed
Mitra, S. (2006), The capability approach and disability. Journal of Disability Policy Studies, 16(4), 236-247.CrossRefGoogle Scholar
Morris, E., Rosenbluth, D., Scott, D., Livingstone, T., Lix, L., McNutt, M. and Watsonj, F. (2006), To What Extent Does Poor Health Precede Welfare? Canadian Journal of Public Health, 96(3), 201-205.CrossRefGoogle Scholar
Mroz, T.A. and Savage, T.H. (2006), The long-term effects of youth unemployment. The Journal of Human Resources, 41(2), 259-293.CrossRefGoogle Scholar
Murali, V. and Oyebode, F. (2004), Poverty, social inequality and mental health. Advances in Psychiatric Treatment, 10, 216-224.CrossRefGoogle Scholar
Nørup, I. (2020), Social marginalization and chronic illness: a critical analysis of the role of labour-market exclusion. Acta Sociologica, 63(2), 173-190.CrossRefGoogle Scholar
Ohram Naper, S. (2009), All-cause and cause-specific mortality of social assistance recipients in Norway: A register-based follow-up study. Scandinavian Journal of Public Health, 37, 820−825.CrossRefGoogle ScholarPubMed
OECD (2018), Health at a glance 2018. Paris: OECD.Google Scholar
Olesen, S.C., Butterworth, P., Leach, L.S., Kelaher, M. and Pirkis, J. (2013), Mental health affects future employment as job loss affects mental health: findings from a longitudinal population study. BMC Psychiatry, 13(144).CrossRefGoogle ScholarPubMed
Overbye, E. and Saebo, G. (1998), Cumulative patterns of well-being among young social assistance recipients versus other youths. Scandinavian Journal of Social Welfare, 7, 174-179.CrossRefGoogle Scholar
Pacheco, G., Page, D. and Webber, D.J. (2014), Mental and physical health: re-assessing the relationship with employment propensity. Work, Employment and Society, 28 (3), 407−429.CrossRefGoogle Scholar
Patrick, R. and Fenney, D. (2015), Disables people, conditionality and a civic minimum in Britain: reflections from qualitative research. Pp. 25-42 in Grover, C. and Piggott, L. (eds.) Disabled people, work and welfare. Is employment really the answer? Bristol: Policy Press.Google Scholar
Pinfold, V., Toulmin, H., Thornicroft, G., Huxley, P., Farmer, P. and Graham, T. (2003), Reducing psychiatric stigma and discrimination: evaluation of educational interventions in UK secondary schools. The British Journal of Psychiatry, 182(4), 342-346.CrossRefGoogle ScholarPubMed
Power, E., Clarke, M., Kelleher, I., Coughlan, H., Lynch, F., Connor, C., Fitzpatrick, C., Harley, M. and Cannon, M. (2015), The association between economic inactivity and mental health among young people: a longitudinal study of young adults who are not in employment, education or training. Irish Journal of Psychological Medicine, 32, 155-160.CrossRefGoogle ScholarPubMed
Reiss, F. (2013), Socioeconomic inequalities and mental health problems in children and adolescents: A systematic review. Social Science & Medicine, 90, 24-31.CrossRefGoogle ScholarPubMed
Rodwell, L., Romaniuk, H., Nilsen, W., Carlin, J.B., Lee, K.J. and Patton, G.C. (2017), Adolescent mental health and behavioural predictors of being NEET: a prospective study of young adults not in employment, education, or training. Psychological Medicine, 48(5), 861-871.CrossRefGoogle ScholarPubMed
Rovny, A. (2014), The capacity of social policies to combat poverty among new social risk groups. Journal of European Social Policy, 24(5), 405-423.CrossRefGoogle Scholar
Schilling, E.A., Aseltine, R.H. and Gore, S. (2007), Adverse childhood experiences and mental health in young adults: a longitudinal survey. BMC Public Health, 7, 30.CrossRefGoogle ScholarPubMed
Schmillen, A. and Umkehrer, M. (2017), The scars of youth: effects of early-career unemployment on future unemployment experience. International Labour Review, 156(3-4), 465-494.CrossRefGoogle Scholar
Schomerus, G., Lucht, M., Holzinger, A., Matschinger, H., Carta, M.G. and Angermeyer, M.C. (2011), The Stigma of Alcohol Dependence Compared with Other Mental Disorders: A Review of Population Studies. Alcohol and Alcoholism, 46(2), 105–112.CrossRefGoogle ScholarPubMed
Shahidi, F.V., Ramraj, C., Sod-Erdene, O. and Siddiqi, A. (2019), The impact of social assistance programs on population health: a systematic review of research in high-income countries. BMC Public Health, 19(2).CrossRefGoogle ScholarPubMed
Sharac, J., Mccrone, P., Clement, S. and Thornicroft, G. (2010), The economic impact of mental health stigma and discrimination: a systematic review. Epidemiology and Psychiatric Sciences, 19(3), 223-232.CrossRefGoogle ScholarPubMed
Suvisaari, J., Aalto-Setälä, T., Tuulio-Henriksson, A., Härkänen, T., Saarni, S., Perälä, J., Schreck, M., Castaneda, A., Hintikka, J., Kestilä, L., Lähteenmäki, S., Latvala, A., Koskinen, S., Marttunen, M., Aro, H. and Lönnqvist, J. (2009), Mental disorders in young adulthood. Psychological Medicine, 39, 287-299.CrossRefGoogle ScholarPubMed
Tanhua, H. and Kiuru, S. (2019), Toimeentulotuki 2018 [Social assistance 2018] [in Finnish]. Finnish Institute for Health and Welfare: Statistical report no. 20.Google Scholar
Taylor, M.J. and Baruch, A.S. (2004), Personal, Family, and Multiple Barriers of Long-Term Welfare recipients. Social Work, 49(2), 175-183.CrossRefGoogle ScholarPubMed
Vaalavuo, M. (2016a), The development of healthcare use among a cohort of Finnish social assistance clients: testing the social selection hypothesis. Sociology of Health & Illness, 38(8), 1272–1286.CrossRefGoogle ScholarPubMed
Vaalavuo, M. (2016b), Deterioration in health: what is the role of unemployment and poverty? Scandinavian Journal of Public Health, 44,347-353.CrossRefGoogle ScholarPubMed
Vanttaja, M. and Järvinen, T. (2006), The young outsiders: the later life courses of ‘drop-out youths’. International Journal of Lifelong Education, 25(2), 173-184.CrossRefGoogle Scholar
Vozoris, N.T. and Tarasuk, V.S. (2004), The Health of Canadians on Welfare. Canadian Journal of Public Health, 95(2), 115-120.CrossRefGoogle ScholarPubMed
Walther, A. (2006), Regimes of youth transitions. Choice, flexibility, and security in young people’s experiences across different European contexts. Young, 14(2), 119-139.CrossRefGoogle Scholar