Quantifying the burden of depressive symptoms in older Americans that is attributable to involuntary job loss: a counterfactual approach

1992-2018年间美国老年人抑郁症状的负担 可归因于非自愿失业，以及对各种机制的干预程度 可以缓解它，还没有估计。长期目标是确定关键机制(例如， 失去医疗保险、失业、再就业不足、经济困难等)那 影响失业后的老年美国人的抑郁症状，以指导政策 和干预措施。作为实现这一长期目标的第一步，此应用程序的目标是 量化美国老年人因工作而产生的抑郁症状的负担 损失，对时变的混杂进行调整，并将再就业时间作为一个整体进行评估 机制。中心假设是，非自愿失业增加了抑郁症的负担 老年美国人的症状是经济能力有限，失业是关键之一 发生这种情况的机制。这个项目的基本原理是，还没有人分析过 来自健康和退休研究(HRS)的数据，使用反事实框架或利用 纵向数据的充分丰富性，这样做将对确定机制至关重要 从而采取干预措施缓解老年人的抑郁症状。这一假说将 通过追求两个具体目标进行测试：1)比较HRS在以下情况下的抑郁症状负担 观察到的就业历史表明，如果没有人遭受 随访期非自愿性失业。2)比较HRS在以下情况下的抑郁症状负担 观察就业历史，看看如果每个经历过工作的人 随诊期间的损失很快就被重新雇用了。对于这两个目标，参数g公式将是 用于估计假设性干预下的反事实结果，同时控制 时变混杂。这项拟议的研究具有创新性，因为它不是比较 那些失去工作的人被那些没有失去工作的人所取代，它用假设的方式来框定这个问题 就业干预措施，以估计抑郁症状负担的变化 在这些干预措施下，在整个人口中都会观察到。建议数 这项研究意义重大，因为这个年龄段的一半以上的美国人将经历 非自愿失业；拟议的严格分析将提供对 抑郁症状的相应负担以及这些症状可能达到的程度 通过再就业缓解，最终有助于确定干预措施的优先事项。

The burden of depressive symptoms among older Americans over the period 1992-2018 that is attributable to involuntary job loss, and the extent to which intervening on various mechanisms could mitigate it, have not been estimated. The long-term goal is to identify key mechanisms (e.g., loss of health insurance, unemployment, inadequate reemployment, financial hardship, etc.) that affect depressive symptoms over time in older Americans after job loss, in order to guide policy and interventions. As the first step toward this long-term goal, the objective of this application is to quantify the burden of depressive symptoms among older Americans that is attributable to job loss, adjusting for time-varying confounding, and to evaluate time to reemployment as one mechanism. The central hypothesis is that involuntary job loss increases the burden of depressive symptoms among older Americans of limited means and that unemployment is one of the key mechanisms by which this occurs. The rationale for this project is that no one has yet analyzed data from the Health and Retirement Study (HRS) using a counterfactual framework or leveraging the full richness of the longitudinal data, and doing so will be essential for identifying mechanisms and thus interventions to alleviate depressive symptoms among older adults. The hypothesis will be tested by pursuing two specific aims: 1) Compare depressive symptoms burden in HRS under the observed employment histories to what would have happened if no one had ever suffered an involuntary job loss during follow-up. 2) Compare depressive symptoms burden in HRS under the observed employment histories to what would have happened if everyone who experienced a job loss during follow-up had soon been reemployed. For both aims, the parametric g-formula will be applied to estimate counterfactual outcomes under hypothetical interventions while controlling for time-varying confounding. The proposed research is innovative because, instead of comparing those who lost a job to those who did not, it frames the question in terms of hypothetical interventions on employment to estimate changes in the burden of depressive symptoms that would have been observed in the whole population under those interventions. The proposed research is significant because more than half of Americans in this age group will experience an involuntary job loss; the rigorous analysis proposed will provide estimates of both the corresponding burden of depressive symptoms and the extent to which these symptoms can be mitigated by reemployment, ultimately helping to set priorities for interventions.