The positive association between employment and self-reported mental health in the USA: a robust application of marginalized zero-inflated negative binomial regression (MZINB)
Abstract Background Few studies have assessed the impact of employment on mental health among chronically ill patients. This study investigated the association between employment and self-reported mental unhealthy days among US adults. Methods For this cross-sectional cohort study, we pooled 2011–2017 Behavioral Risk Factor Surveillance System (BRFSS) survey data. We examined the association between employment and mental health in nine self-reported chronic conditions using marginalized zero-inflated negative binomial regression (MZINB). All analyses were conducted using SAS statistical software 9.4. Results Respondents (weighted n = 245 319 917) were mostly white (77.16%), aged 18–64 (78.31%) and employed (57.08%). Approximately 10% of respondents reported one chronic condition. Expected relative risk of mental unhealthy days was highest for employed respondents living with arthritis (RR = 1.70, 95% CI = [1.66, 1.74]), COPD (RR = 1.45, 95% CI = [1.41, 1.49]) and stroke (RR = 1.31, 95% CI = [1.25, 1.36]) compared to unemployed respondents. Employed males had 25% lower risk of self-reported mental unhealthy days compared to females. Conclusions Results show the interactive effects of employment on self-reported mental health. Employment may significantly impact on self-reported mental health among patients suffering from chronic conditions than those without chronic conditions.