The association of unemployment with mental health disorders has been convincingly demonstrated in earlier studies. There is ample evidence of both health selection and social causation mechanisms, whereas the research on the identification of mental health disorders among unemployed people is scanty. Also, little attention has been paid in earlier research to the ability to work of unemployed people and to its assessment. Their health care attendance may be one crucial factor behind both the identification of mental health disorders and the (lacking) assessment of work ability among unemployed people. Previous findings on the health care attendance of unemployed people have been inconsistent with both increased and decreased visits to health care reported.
The material of this register study comprised the health records of the Eligibility for a Disability Pension (EDIPE) project in the Finnish city of Tampere from 2001 to 2007. All participants of the EDIPE project were long-term (over one year) unemployed people with work disabilities and low employability. The national level EDIPE project was launched on the assumption that a notable proportion of longterm unemployed people are incapable of work and would be entitled to a disability pension.
The studies of which this dissertation is composed investigated the identification of alcohol-related and depressive disorders in the health and employment services in general and in the EDIPE process. The identification of the disorders was also investigated in relation to disability pensions granted. The association of the different health care attendance styles was studied in relation to alcohol-related and depressive disorders.
The findings of the study show that a notable proportion of long-term unemployed people with alcohol-related or mood disorders lack the ability to work. However, their impaired working ability seems to go unheeded in health care although there are also signs in some respects of an adequate identification and wellfunctioning service system. The alcohol-related disorders were identified and diagnosed in health care among those long-term unemployed people who were granted a disability pension due to EDIPE examinations.
The proportion of those people with separate depression without somatic comorbidity was scanty in the study register. Indirectly, it could be interpreted that those long-term unemployed people with eligibility for a disability pension due to depression are adequately identified in regular health care since depression is nowadays the single most frequent reason for work disability in Finland (Finnish Centre for Pensions, 2019).
The alcohol-related disorders seem to be identified in health care among those long-term unemployed people who would be eligible for a disability pension. However, their working ability is not assessed. The employment authorities seem to be aware of the need for work ability assessment. They may not, however, offer significant assistance in the identification of alcohol-related disorders among those long-term unemployed people who would be entitled for a disability pension (Study I).
Also, a notable proportion of the depressive disorders remains unidentified among those long-term unemployed people who would be eligible for the disability pension (Study III). This may be explained at least partly by the duration of unemployment, as the identification of depression decreases as the unemployment spell grows longer (Study II). The identification of depressive and alcohol-related disorders or their initiation working ability assessment processes may also be associated with the faltering or marginalised health care attendance style among longterm unemployed people with alcohol-related or depressive disorders (Study IV).
According to the findings of the study health care services allocated especially for unemployed people are recommended. Also, professionals working with long-term unemployed people should be trained to be more perceptive in identifying mental health disorders among their clients and screening for depression should be considered, especially among those long-term unemployed with impaired work ability and physical disorders.
In future artificial intelligence applications could possibly be included in the digital patient management systems to enhance the identification of health care attendance styles to screen for people at increased risk for mental health disorders, work disabilities and of drifting into long-term unemployment.
The doctoral dissertation of MD Kirsi Nurmela in the field of social psychiatry titled Identification of Mental Health Disorders among Long-term Unemployed People and Their Ability to Work. Does health care meet the case? will be publicly examined at the Faculty of Social Sciences of Tampere University at 12 o'clock on Friday 21 May, 2021. The venue is Arvo building auditorium F114, address: Arvo Ylpön katu 34. Docent Tanja Laukkala from the University of Helsinki will be the opponent while Professor Sami Pirkola will act as the custos.
The event can be followed via remote connection, meeting ID ID 680 9869 4046.
The dissertation is available online at
http://urn.fi/URN:ISBN:978-952-03-1949-6
Photo: Harri Hinkka