Health and re-employment in a two year follow up of long term unemployed.

STUDY OBJECTIVE The aim was to examine re-employment and changes in health during a two year follow up of a representative sample of long term unemployed. DESIGN This was a cross sectional study and a two year follow up. Health was measured by psychometric testing, Hopkins symptom checklist, General health questionnaire, and medical examination. Health related selection to continuous unemployment and recovery by re-employment was estimated by logistic regression with covariances deduced from the labour market theories of human capital and segmented labour market. SETTING Four municipalities in Greenland, southern Norway. SUBJECTS Participants were a random sample of 17 to 63 year old people registered as unemployed for more than 12 weeks. MAIN RESULTS In the cross sectional study, the prevalence of depression, anxiety, and somatic illness was from four to 10 times higher than in a control group of employed people. In the follow up study, there was considerable health related selection to re-employment. A psychiatric diagnosis was associated with a 70% reduction in chances of obtaining a job. Normal performance on psychometric testing showed a two to three times increased chance of re-employment. Recovery of health following re-employment was less than expected from previous studies. CONCLUSIONS Health related selection to long term unemployment seems to explain a substantial part of the excess mental morbidity among unemployed people. An increased proportion of the long term unemployed will be vocationally handicapped as years pass, putting a heavy burden on social services.