Costs of Health Service Use among Unemployed and Underemployed People with Mental Health Problems

Background: Unemployment is associated with a high risk of experiencing mental illness. This can lead to stigmatisation, reduced quality of life, and long-term costs like increased healthcare expenditure and productivity losses for society as a whole. Previous research indicates evidence for an association between unemployment and higher mental health service costs, but there is insufficient information available for the German healthcare system. Aim of the Study: This study aims to identify costs and cost drivers for health and social service use among unemployed people with mental health problems in Germany. Methods: A sample of 270 persons participated at baseline and six-month-follow-up. Healthcare and social service use was assessed using the Client Socio-Demographic and Service Receipt Inventory. Descriptive cost analysis was performed. Associations between costs and potential cost drivers were tested using structural equation modelling. Results: Direct mean costs for 12 months range from (sic)1265.13 (somatic costs) to (sic)2206.38 (psychiatric costs) to (sic)3020.70 (total costs) per person. Path coefficients indicate direct positive effects from the latent variable mental health burden (MHB) on stigma stress, somatic symptoms, and sick leave. Discussion: The hypothesis that unemployed people with mental health problems seek help for somatic symptoms rather than psychiatric symptoms was not supported. Associations between MHB and costs strongly mediated by sick leave indicate a central function of healthcare provision as being confirmation of the inability to work. Implications for Health Policies: Targeted interventions to ensure early help-seeking and reduce stigma remain of key importance in reducing long-term societal costs. Implications for Further Research: Future research should explore attitudes regarding effective treatment for the target group.