This Australian longitudinal study examined how voluntary and involuntary changes in employment status affect mental health (MHI-5) in adults aged 45–69, comparing those with persistent disability, fluctuating disability, and no disability, using 13 waves of HILDA Survey data (n=9,162) with fixed-effects regression models.
For people with persistent disability, both involuntary (−4.51, 95% CI −6.79 to −2.24) and voluntary unemployment (−3.62, 95% CI −5.43 to −1.82) were linked to worse mental health versus employment. Fluctuating disability showed similar patterns (involuntary: −4.98; voluntary: −1.26). People without disability only showed worse mental health with involuntary unemployment (−2.45, 95% CI −3.80 to −0.69).
- Disability status was classified as persistent, fluctuating, or absent across waves, but the specific types or severity of disability were not distinguished. - Voluntary unemployment includes both retirement and other exits, which may have different mental health implications that were not separated. - Findings are from one country (Australia) with a specific welfare system, limiting generalizability.
For patients with disability in later working life, even a planned or voluntary exit from work carries a real risk of mental health decline—unlike those without disability, for whom only involuntary job loss is harmful. Clinicians should screen for depression and anxiety when patients with disability transition out of employment, regardless of whether that transition was chosen.
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