Effects on mental health of a UK welfare reform, Universal Credit: a longitudinal controlled study
Effects on mental health of a UK welfare reform, Universal Credit: a longitudinal controlled study
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DOI：
10.1016/s2468-2667(20)30026-8
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发表时间：
2020-03-01
影响因子：
50
通讯作者：
Barr, Ben
中科院分区：
文献类型：
--
作者：
Wickham, Sophie;Bentley, Lee;Barr, Ben
2013年4月，英国的一项福利改革“通用信贷”开始取代现有的六项福利计划，首先是基于收入的求职者津贴。我们的目的是确定引入通用信贷对心理健康的影响。在这项纵向对照研究中，我们将2009年至2018年期间参加英国理解社会纵向家庭小组研究的52187名工作年龄（16-64岁）的英格兰、威尔士和苏格兰人的197111次观察结果与每个受访者居住地区引入通用信贷当月的行政数据联系起来。我们纳入了有就业状况、当地政府居住区域、心理困扰和混杂变量数据的参与者。我们排除了来自北爱尔兰的个人和失去工作的残疾人。我们对这项具有全国代表性的纵向家庭调查进行了差异中差异分析，并将受访者分为两组：有资格获得通用信贷的失业者（干预组）和没有失业的人，因此通常没有资格获得通用信贷（对照组）。利用逐步推出的通用信贷，我们比较了干预组和对照组之间心理困扰的变化（通过一般健康问卷-12自我报告），因为改革在每个受访者居住的地区被引入。我们将临床显著的心理困扰定义为在一般健康问卷-12中得分大于3分。我们测试了不同亚组（年龄、性别和教育程度）之间是否存在差异效应。在考虑到潜在的混杂因素后，在引入通用信用后，干预组的心理困扰患病率相对于对照组增加了6.57个百分点（95% CI 1.69-11.42）。我们估计，在2013年4月29日至2018年12月31日期间，由于普遍信贷的引入，额外的66374 （95% CI 10 042-117 307）失业人员将经历临床上显著的心理困扰水平；其中21760人可能达到了抑郁症的诊断阈值。我们的研究结果表明，在受该政策影响的人群中，通用信贷的引入导致了心理困扰（一种衡量心理健康困难的指标）的增加。未来对政府福利制度的改革不仅应该从财政角度进行评估，还应该从它们对健康和福祉的潜在影响角度进行评估。版权所有(C) 2020作者。Elsevier Ltd.出版。
Background Universal Credit, a welfare benefit reform in the UK, began to replace six existing benefit schemes in April, 2013, starting with the income-based job Seekers Allowance. We aimed to determine the effects on mental health of the introduction of Universal Credit.Methods In this longitudinal controlled study, we linked 197111 observations from 52187 individuals of working age (16-64 years) in England, Wales, and Scotland who participated in the Understanding Society UK Longitudinal Household Panel Study between 2009 and 2018 with administrative data on the month when Universal Credit was introduced into the area in which each respondent lived. We included participants who had data on employment status, local authority area of residence, psychological distress, and confounding variables. We excluded individuals from Northern Ireland and people out of work with a disability. We used difference-in-differences analysis of this nationally representative, longitudinal, household survey and separated respondents into two groups: unemployed people who were eligible for Universal Credit (intervention group) and people who were not unemployed and therefore would not have generally been eligible for Universal Credit (comparison group). Using the phased roll-out of Universal Credit, we compared the change in psychological distress (self-reported via General Health Questionnaire-12) between the intervention group and the comparison group over time as the reform was introduced in the area in which each respondent lived. We defined clinically significant psychological distress as a score of greater than 3 on the General Health Questionnaire-12. We tested whether there were differential effects across subgroups (age, sex, and education).Findings The prevalence of psychological distress increased in the intervention group by 6.57 percentage points (95% CI 1.69-11.42) after the introduction of Universal Credit relative to the comparison group, after accounting for potential confounders. We estimate that between April 29, 2013, and Dec 31, 2018, an additional 63 674 (95% CI 10 042-117 307) unemployed people will have experienced levels of psychological distress that are clinically significant due to the introduction of Universal Credit; 21760 of these individuals might reach the diagnostic threshold for depression.Interpretation Our findings suggest that the introduction of Universal Credit led to an increase in psychological distress, a measure of mental health difficulties, among those affected by the policy. Future changes to government welfare systems should be evaluated not only on a fiscal basis but on their potential to affect health and wellbeing. Copyright (C) 2020 The Author(s). Published by Elsevier Ltd.