Informing mental health initiatives for workers

Research summary

Across two projects, researchers used linked administrative data to explore how mental ill health varies across occupations in Northern Ireland (NI), and examine the influence of family responsibilities and the Covid-19 pandemic. Findings were presented to members of the NI Mental Health Charter for employers and service providers, as well as incorporated into relevant training resources.

The first project examined rates of mental health conditions across broad occupational groups in NI’s working population. It also analysed how family responsibilities (dependent children, lone-parenthood, and informal caregiving) affect mental health across these occupations. The analysis controlled for key social determinants such as age, gender, marital status, socio-economic position, area of residence, and the presence of other health conditions.  

The second project assessed whether the pandemic period coincided with changes in the use of anti-depressant, anxiety, and sleep medication among workers in different occupation groups. Using pre-pandemic mental health prescription trends, forecasted trends were estimated during the pandemic period and compared with actual trends, to determine if mental health among individuals within particular occupation groups was negatively impacted by the pandemic.

Data used

The first project used linked administrative data from:

• 2011 NI Census returns
• NI Properties Data
• NI Enhanced Prescribing Data (EPD) 2011/12.

The researchers examined self-reported mental health conditions and prescriptions of anti-depressant, anxiety, and sleep medication among 553,925 workers aged between 25 and 59.

The second project used EPD linked with NI Longitudinal Study (NILS) data to examine trends in these medications from 2011 to 2021, among 200,004 NI workers across nine major occupation groups. Quarterly prescription patterns were examined prior to and during pandemic restrictions (from the start of 2011 to the end of 2019, and the start of 2020 to the end of 2021).

Methods used

The first project analysed how common self-reported mental health conditions and prescriptions of anti-depressant, anxiety, and sleep medication were over a 12-month period across different job types. It then explored how job type and family responsibilities – such as having children or caregiving – affected these outcomes for males and females separately.

The second project looked at how often these medications were prescribed each quarter, comparing trends before and after the Covid-19 pandemic (from late 2019 to the end of 2021). A statistical forecasting method was used to compare ‘forecasted’ and ‘observed’ rates during the pandemic period, helping to identify which job sectors were most affected.

Research findings

The first project found:

• Self-reported chronic mental ill health was more prevalent among workers in lower paid occupations, while ‘public-facing’ occupations had the highest rates of prescriptions.
• Over and above other contextual factors, informal caregivers were less likely to report mental health problems, but more likely to be in receipt of anti-depressant, anxiety, and sleep medication, as were lone parents.
• The association of family demands also varied across occupation groups.

The second project found:

• Early to mid-2020 coincided with lower-than-expected receipt of anti-depressant and anxiety medications for several broad occupation types.
• Receipt of anxiety medications among managers, directors, and senior officials dropped below expected levels from mid-late 2020 to early 2021.
• There was a notable increase in anti-depressant prescriptions for a prolonged period among staff in caring/leisure and related professions, as well as higher rates of sleep medications in early-mid 2021.

Research impact

The first project showed that mental ill-health rates vary substantially across occupations and are substantially influenced by family circumstances. Furthermore, the second suggests that occupation type was an important risk factor in terms of the adverse mental health impact of the Covid-19 pandemic.

This provides useful evidence to inform the implementation of ‘mental health at work plans’, as recommended by the UK Government’s ‘Thriving at Work’ report (2017) which outlines ‘core standards’ that should be adopted by all UK companies.

Following peer review and publication, the researchers were invited by the NI Equality Commission to present their findings to members of the NI Mental Health Charter for employers and service providers. The Charter, which currently has 345 signees (NI-based companies and organisations), provides a framework for working towards healthy workplaces, with those signing up to the Charter agreeing to work towards five charter commitments. The key findings were also embedded within Charter training resources, providing occupation-specific evidence on mental health that will support members in meeting their commitments.

Research outputs

Publications and reports

Ferry F, Rosato M, Curran E, Leavey G. Occupation type, family demands and mental health: analysis of linked administrative data. J Ment Health. 2024 Apr;33(2):150-158. doi: 10.1080/09638237.2023.2182416. Epub 2023 Mar 6. PMID: 36876750.

Curran E, Rosato M, Ferry F, Leavey G. Mental ill-health among health and social care professionals: an analysis using administrative data. Int J Popul Data Sci. 2021 Jul 27;6(1):1649. doi: 10.23889/ijpds.v6i1.1649. PMID: 34381877; PMCID: PMC8318063.

Ferry F, Bunting B, Rosato M, Curran E, Leavey G. The impact of reduced working on mental health in the early months of the COVID-19 pandemic: Results from the Understanding Society COVID-19 study. Journal of Affective Disorders. 2021 May 15;287:308-15.

Trends in psychotropic medication across occupation types before and during the Covid- 19 pandemic: a linked administrative data study. (Under review)

Public engagement and involvement

A range of external stakeholders have been engaged in these projects from an early stage, including MindWise, Carers NI, Action Mental Health, the NI Department for Communities, Irish Congress of Trade Unions, and the NI Equality Commission.

Blogs, news reports and videos

Data Insight: Mental Disorder, Occupation Type and Family Demands (August 2020):

Blog: The relationship between mental disorder, occupation type and family demands (September 2020):

Presentations and awards

• Presentation at NI Equality Mental Health Charter Event January 2022. Two presentations given to Mental Health Charter members (representing employers and managers from across NI).
• ADRC NI Policy Symposium Series: Caring and working through COVID: how the pandemic has affected workers' mental health. Online event March 2021 hosted by ADRC NI with large attendance including representation from NI health Trusts, NHS Scotland and England, a range of UK universities, DAERA, Aware NI, Federation of Small Businesses, Scottish local councils, Voluntary and Community Sector organisations and Trade Unions. Two presentations were delivered based on our work:

1. How can administrative data contribute to the evidence base on work and mental health? Findings from the OCCUMEN study. Dr Emma Curran, Research Fellow, ADRC NI and Dr Finola Ferry, ADRC NI
2. The impact of reduced working on mental health in the early months of the COVID-19 pandemic. Dr Finola Ferry, ADRC NI

• Presentation at the annual ADR UK conference in Cardiff December 2019. The OCCUMEN study: An examination of mental health across occupations and association of family responsibilities.

Acknowledgements

The help provided by the staff of the Northern Ireland Longitudinal Study (NILS) and the NILS Research Support Unit is acknowledged.  The NILS is funded by the Health and Social Care Research and Development Division of the Public Health Agency (HSC R&D Division) and Northern Ireland Statistics and Research Agency (NISRA).  The NILS-RSU is funded by the ESRC and the Northern Ireland Government. The authors alone are responsible for the interpretation of the data and any views or opinions presented are solely those of the author and do not necessarily represent those of NISRA/NILS. The Census and Honest Broker Service (HBS)/ Business Services Organisation (BSO) data has been supplied for the sole purpose of this project.

The support and guidance of steering committee members representing MindWise, Carers NI, Action Mental Health, the NI Department of the Economy, NI Department for Communities, Irish Congress of Trade Unions, and the NI Equality Commission is also acknowledged.