author: Carstens, C., & Massatti, R. 
year: 2018
title: Predictors of labor force status in a random sample of consumers with serious mental illness
publisher: Journal of Behavioral Health Services & Research
uri: https://doi.org/10.1007/s11414-018-9597-8
pubtype: article
discipline: health services

country: United States
period: 2014-2015
maxlength: 1
targeting: explicit
group: mentally ill
data: survey data

design: observational
method: multinomial logistic regression model
sample: 917
unit: individual
representativeness: national
causal: 0 # 0 correlation / 1 causal

theory: human capital theory; strength-based therapy
limitations: small sample due to low response rate; over-representation of women, older persons, racial minorities
observation:
  - intervention: subsidy (health care)
    institutional: 1
    structural: 1
    agency: 0
    inequality: disability
    type: 1 # 0 vertical / 1 horizontal
    indicator: 1 # 0 absolute / 1 relative
    measures: employment probability
    findings: LFP significantly increased for employment incentives; significantly reduced for employment barriers and Medicaid ABD programme participation; marginally reduced for 
    channels: Medicaid ABD generates benefits trap of disability determination
    direction: -1 # -1 neg / 0 none / 1 pos
    significance: 2 # 0 nsg / 1 msg / 2 sg

notes: employment motivators captured as increased responsibility and problem-solving, stress management, reduced depression and anxiety; employment barriers
annotation: |
  An analysis of the potential factors influencing mentally ill individuals in the United States to participate in the labour force, using correlation between different programmes of Medicaid and labour force status.
  In trying to find labour force participation predictors it finds employment motivating factors in reduced depression and anxiety, increased responsibility and problem-solving and stress management being positive predictors.
  In turn barriers of increased stress, discrimination based on their mental, loss of free time, loss of government benefits and tests for illegal drugs were listed as barriers negatively associated with labour force participation.
  For the government benefits, it finds significant variations for the different varieties of Medicaid programmes, with the strongest netagive labour force participation correlated to Medicaid ABD, a programme for which it has to be demonstrated that an individual cannot work due to their disability.
  The authors suggest this shows the primary channel of the programme becoming a benefit trap, with disability being determined by not working and benefits disappearing when participants enter the labour force, creating dependency to the programme as a primary barrier.
  Two limitations of the study are its small sample size due to a low response rate, and an over-representation of racial minorities, women and older persons in the sample mentioned as introducing possible downward bias for measured labour force participation rates.