Job Loss and Mortality

In my clinical practice some years back I saw “Mr. A,” a man in his early 50’s who had become profoundly depressed after losing his job. We had a good relationship and he was very cooperative in his treatment, which involved medications, different forms of psychotherapy, and environmental manipulations. Despite all our efforts, nothing worked. He remained depressed for close to two years, at which point a friend found a job for him.

His depression lifted almost instantly! He performed well at the job and remained free of depression for the several years we stayed in contact.

At about the same time I read Thomas Cottle’s Hardest Times: The Trauma of Long-Term Unemployment. Through stories of men who were out of work and unable (yet) to find new jobs, Cottle demonstrated just how severe a trauma unemployment could be. Shame and hopelessness were common reactions. In my medical career I’d never experienced an iota of fear about unemployment. Cottle’s book helped me be more empathic with patients – and friends – who were out of work.

A recently published study of Recessions, Older Workers, and Longevity from the National Bureau of Economic Research adds statistical weight to these clinical impressions. The researchers used the government database of vital statistics to investigate the impact of job loss at the population level. They investigated mortality data between 1969 and 2008 to examine long term survival trends for age-specific cohorts in relation to labor conditions. The data demonstrated that workers who became unemployed at 58 as a result of recession on average lived three years less than comparable workers who did not become unemployed (19 years instead of 22).

Statistics don’t tell us what caused the loss of longevity, but the authors speculate that job loss in one’s 50s means reduced income before eligibility for Social Security kicks in at 62. Reduced income affects diet, housing, and other health-relevant factors. And in our fragmented health care “system,” prolonged job loss typically means loss of health insurance and decreased access to health care before Medicare becomes available at 65. Add to that the fact that smoking and alcohol use often increase with unemployment and exercise often decreases, and we have a witches brew of health and longevity- reducing factors.

For over 65ers, loss of work may mean loss of meaning, and, for many, loss of economic security as well. But there is less shame than for loss of work earlier in life, since over 65ers aren’t “supposed” to be working. And although Social Security income is limited, it is secure, and provides more of a safety net than under 65ers are likely to have. Taking social security at 62, the initial point of eligibility, provides an element of safety, but the monthly payout is approximately 30% less than it would be at the “full retirement” age of 66. (A useful government publication on the topic is available here.)

In policy discussions we tend to put health care and finances in separate silos. This doesn’t make sense. Poor health makes us less productive and less employable. Unemployment makes us less healthy and leads to shortened life span. The longer late middle age boomers remain unemployed in the current recession, the more severe the consequences will be for population health in years to come.

James Sabin, M.D., 73, is an organizer of Over 65 and a clinical professor of psychiatry at Harvard Medical School.