Health and Employment for Adults with Serious Mental Illness: An Examination of Physical Health Conditions, Healthcare Utilization, Health-Related Quality of Life, and Employment

Abstract

Mounting chronic condition rates, elevated healthcare spending, and increased attention to the importance of structural and social health determinants, have magnified attention to disparities in health and healthcare in the United States. Adults with serious mental illness (SMI) have higher rates of many chronic physical health conditions when compared to the general U.S. population, and co-occurring physical and mental health conditions are associated with higher use of emergency healthcare services and higher healthcare costs compared to those with only one condition. At the same time, while adults with SMI express a desire to work, they experience high rates of unemployment. Research indicates that mental health symptoms and mental health care are related to employment for adults with SMI, however there is a need for further inquiry regarding the roles of physical health and healthcare. Drawing on three theoretical perspectives-the social determinants of heath framework, the health as human capital model, and the behavioral model for health service utilization-this dissertation examined relationships between physical health conditions, healthcare, health-related quality of life, and employment for adults with SMI, at both the bivariate and multivariate levels. Direct and indirect relationship were examined using structural equation modeling (n = 645), and findings suggested that individuals with SMI and co-occurring physical health conditions had higher use of healthcare, and lower health-related quality of life, compared to those with SMI only. Further, healthcare receipt and health-related quality of life mediated relationships between physical health conditions and employment status, and physical health-related quality of life had a stronger relationship with employment than mental health-related quality of life. The findings of this dissertation are discussed, and implications for future research, social work practice, and health policy are provided.