Past research has found strong associations between common mental disorders and adverse social outcomes such as school drop-out, teen pregnancy, unemployment, marital instability and impairment in role functioning. However, most studies of these associations in the US have been based on cross-sectional data or selected populations. Cross-sectional studies cannot disentangle reciprocal associations likely to exist between mental disorders and social adversities and studies based on selected samples cannot be generalized to the whole population. Prospective data in representative samples of the entire population are needed. There are few such studies with a focus on mental health in the US. While the associations of mental disorders with social outcomes have been studied in birth cohort and other longitudinal studies in other industrialized countries, variations in contextual factors, such as school systems, job markets, and unemployment insurance policies hinder generalization of results to the US. There is a need for comparable US studies to document the adverse consequences of mental disorders in the US. In this project, we propose to examine the development of adverse social and functional outcomes in individuals with lifetime histories of mood, anxiety, substance and conduct disorders in the 5,001 participants of the US National Comorbidity Survey between ages 15-54 at baseline who were followed-up and re-interviewed 10 years later.
In Aim 1 we determine the extent to which baseline mental disorders predict subsequent disruptions in schooling, employment and marriage as well as earnings.
In Aim 2 we focus on the associations of pre-existing mental disorders with subsequent impairments in role functioning.
In Aim 3 we look at social adversities at the population level and determine the proportion of these outcomes that can be attributed to mental disorders at the population level.
In Aim 4, we assess whether the associations of mental disorders with adverse outcomes vary by sex, socio-economic status, and age. Analyses will use propensity score techniques to adjust for observed potential confounders preceding the onset of mental disorders that could explain associations with subsequent outcomes. Results of the study could be useful in ongoing policy debates about the importance of investing in research and treatment of mental disorders and could help identify subgroups for targeted intervention to avert adverse social outcomes.

Public Health Relevance

We will use data from a survey of the US general population with a 10 year follow-up to shed light on the associations of common mental disorders with adverse educational, employment, financial and marital outcomes and with level of functioning in various roles. We will examine whether these associations vary by respondent sex, socio-economic status, and age. And we will examine the extent to which community-level burdens of these adverse social outcomes can be explained by mental disorders.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Research Project (R01)
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Social Sciences and Population Studies Study Section (SSPS)
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Rupp, Agnes
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Johns Hopkins University
Other Health Professions
Schools of Public Health
United States
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