Labor market participation and depression during the COVID-19 epidemic among young adults (18 to 30 years): a nationally representative study in France

  1. Maria Melchior
  2. Aline-Marie Florence
  3. Camille Davisse-Paturet
  4. Bruno Falissard
  5. Cédric Galéra
  6. Jean-Baptiste Hazo
  7. Cécile Vuillermoz
  8. Josiane Warszawski
  9. Fallou Dione
  10. Alexandra Rouquette
  11. the EPICOV study group

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Abstract

Objective

To examine the relationship between young adults’ labor force participation and depression in the context of the COVID-19 pandemic.

Design, Setting, Participants

Data come from the nationally-representative EPICOV cohort study set up in France, and were collected in 2020 and 2021 (3 waves of online or telephone interviews) among 2217 participants aged 18-30 years. Participants with prior mental health disorder (n=50) were excluded from the statistical analyses.

Results

Using Generalized Estimating Equation (GEE) models controlled for participants’ socio-demographic and health characteristics and weighted to be nationally-representative, we found that compared to young adults who were employed, those who were studying or unemployed were significantly more likely to experience depression assessed using the PHQ-9 (multivariate ORs respectively: OR: 1.29, 95% CI 1.05-1.60 and OR: 1.50, 1.13-1.99). Stratifying the analyses by age, we observed than unemployment was more strongly associated with depression among participants 25-30 years than among those who were 18-24 years (multivariate ORs respectively 1.78, 95% CI 1.17-2.71 and 1.41, 95% CI 0.96-2.09). Being out of the labor force was, to the contrary, more significantly associated with depression among participants 18-24 years (multivariate OR: 1.71, 95% CI 1.04-2.82, vs. 1.00, 95% CI 0.53-1.87 among participants 25-30 years). Stratifying the analyses by sex, we found no significant differences in the relationships between labor market characteristics and depression (compared to participants who were employed, multivariate ORs associated with being a student: men: 1.33, 95% CI 1.01-1.76; women: 1.19, 95% CI 0.85-1.67, multivariate ORs associated with being unemployed: men: 1.60, 95% CI 1.04-2.45; women: 1.47, 95% CI 1.01-2.15).

Conclusions and relevance

Our study shows that in addition to students, young adults who are unemployed also experience elevated levels of depression in the context of the COVID-19 pandemic. These two groups should be the focus of specific attention in terms of prevention and mental health treatment. Supporting employment could also be a propitious way of reducing the burden of the Covid-19 pandemic on the mental health of young adults.

Key Points

Question

Is labor force participation associated with young adults’ likelihood of depression during the COVID-19 pandemic?

Findings

In a nationally-representative cohort study in France, compared to young adults who are employed, those who are studying or experience unemployment had elevated odds of depression in 2020 and 2021.

Meaning

Young people are experiencing the highest burden of mental health problems in the context of the COVID-19 epidemic – our study implies that those who are studying or are unemployed are at especially high risk and should be the focus of attention in terms of prevention and treatment.

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  1. ScreenIT

    SciScore for 10.1101/2022.03.25.22272948: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsIRB: Ethics approval: The EPICOV study received approval from an ethics committee (Comité de Protection des Personnes Sud Méditerranée III 2020-A01191-38) and from France’s National Data Protection Agency (Commission Nationale Informatique et Libertés, CNIL, MLD/MFI/AR205138).
    Sex as a biological variableSeveral characteristics were measured at study baseline: sex (female vs. male), age (25-30 vs. 18-24 years), urbanicity (rural area, <100 000 residents, ≥100 000 residents, Paris and suburbs), lone living (yes vs. no), having children (yes vs. no), and presence of a chronic disease (yes vs. no, the most frequent diseases reported were asthma - 4.6%, physical disability - 1.1%, gastro-intestinal disorder - 0.9%, musculo-skeletal disorder - 0.9%, respiratory disorder - 0.6%, diabetes - 0.5%).
    RandomizationAs previously described, participants (≥ 15 years of age, residing in mainland France or three out of five overseas territories) were randomly selected from the national tax database (FIDELI).
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    No key resources detected.

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Limitations and strengths: Our study has limitations which need to be acknowledged prior to interpreting the data. First, the EPICOV study started in the Spring of 2020 and we have only retrospective data on participants’ history of pre-existing mental health problems. Nevertheless, we were able to exclude from the statistical analyses participants who had the most severe forms of psychopathology. While future studies should examine prospective changes in mental health among cohorts of young people followed since prior to the COVID-19 pandemic, our results do not appear to be due to pre-existing severe mental health difficulties. Second, the EPICOV cohort suffered attrition, with participants belonging to socioeconomically disadvantaged groups least likely to participate over the long term (17). This lead us to conduct repeated measures analyses, which make it possible to maximize the use of information provided by study participants and limit possible biases due to attrition. Moreover, our statistical analyses are weighted to render the study sample representative of young adults in France. Third, in the EPICOV cohort, depression was ascertained with the PHQ-9 questionnaire, which is self-reported. While clinical diagnoses may yield a more accurate picture of severe depression, the PHQ-9 has satisfactory validity vs. clinical diagnosis (18) and we specifically studied a level of symptoms consistent with moderate to severe depression. Our study also has strengths which we wou...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2022.03.25.22272948v1 on medRxiv