Moving on trial: protocol for a pilot randomised controlled trial of models of housing and support to reduce risks of COVID-19 infection and homelessness.

BACKGROUND: It is estimated that around 160,000 households in Britain experience homelessness each year, although no definitive statistics exist. Between March and September 2020, as part of the initial 'Everyone In' government response to COVID-19 in England, 10,566 people were living in emergency accommodation and nearly 18,911 people had been moved into settled accommodation. However, some forms of temporary accommodation may not be suitable as shared facilities make it impossible for people to adhere to government guidelines to reduce the spread of COVID-19. METHODS: This is parallel group, pilot randomised controlled trial. The target is to recruit three local authorities, each of which will recruit 50 participants (thus a total of approximately 150 participants). Individuals are eligible if they are aged 18 and over, in a single-person homeless household, temporarily accommodated by the LA with recourse to public funds. Participants will be randomised to receive settled accommodation (intervention group) or temporary accommodation (control group). The intervention group includes settled housing such as Private Rented Sector (low and medium support), Social Housing (low and medium support), and Housing First (High support). The control group will maintain treatment as usual. The follow-up period will last 6 months. The primary outcome is to assess the feasibility of recruitment, retention, and acceptability of trial processes against progression criteria laid out in a traffic light system (green: all criteria are met, the trial should progress as designed in this pilot; amber: the majority of criteria are met and with adaptations to methods all criteria could be met; red: the minority of criteria are met and the pilot RCT should not proceed). Secondary outcomes include assessment of completeness of data collection at 3 and 6 months and percentage of participants consenting to data linkage, as well as a process evaluation and economic evaluation. DISCUSSION: This trial will address feasibility questions associated with progression to a fully powered effectiveness trial of models of housing to reduce risk of COVID-19 infection and homelessness. TRIAL REGISTRATION: ISRCTN69564614 . Registered on December 16, 2020.

Underemployment and psychological distress: Propensity score and fixed effects estimates from two large UK samples.

BACKGROUND: The share of workers who work part-time because full-time jobs are not available remains larger compared to the period prior to the 2008 crisis. For part-time workers, being available to work more hours than offered may have negative mental health implications. METHOD: Drawing on two nationally representative British surveys, we tested whether working less than 30 hours per week while preferring to work longer hours (underemployment) is associated with increased psychological distress. Distress was assessed using responses to the 12-item General Health Questionnaire in both samples. RESULTS: In the National Child Development Study (N = 6,295), propensity score estimates indicated that the hours-underemployed workers experienced higher levels of psychological distress (ß = 0.25, p <0.001) than full-time workers matched on observable characteristics, including prior distress levels. Fixed effects estimates using 18 years of the British Household Panel Survey (N = 8,665) showed that transitioning from full-time employment to underemployment predicted an increase in distress levels (ß = 0.19, p <0.01). Conversely, transitioning from underemployment to full-time employment forecasted a reduction in distress (ß = -0.18, p <0.001). On average, job earnings and perceptions of job security explained a small (≈ 10%) portion of the potential psychological impact of hours-underemployment. CONCLUSIONS: These findings highlight the possibility that underemployment among part-time workers may have detrimental psychological consequences. Policy interventions geared towards improving career opportunities for part-time workers would potentially ameliorate losses in psychological well-being experienced by this group.

Adolescent mental health and unemployment over the lifespan: Population evidence from Sweden.

RATIONALE: Symptoms of mental health problems have been shown to predict adverse labour market outcomes including unemployment, but no studies have used sibling models to examine the relationship between clinically diagnosed psychiatric conditions in adolescence and subsequent unemployment. OBJECTIVE: This study used extensive Swedish registry data to investigate the link between psychiatric conditions diagnosed during military conscription and unemployment over two decades. Further, we identified whether this relation was amplified during an economic downturn and tested whether it was affected by adjustment for unobserved family characteristics using sibling fixed-effects models. METHOD: Psychiatric conditions were diagnosed by psychologists and psychiatrists at military conscription in sample of 929,191 Swedish men (mean age = 18.4 years) between 1969 and 1989. The average number of days unemployed per year was observed from 1992 to 2012, using the records of the Swedish Public Employment Services. RESULTS: After adjustment for physical health and childhood socioeconomic status those diagnosed with any psychiatric condition experienced approximately an additional 10 days per year unemployment compared to others. Alcohol (16 days unemployment) and other substance use disorders (17 days) were the strongest predictors of exposure to future unemployment, followed by personality disorders (10 days), neurotic and adjustment conditions (nine days), and depressive disorders (six days). Family background factors accounted for approximately half of the observed relationship between mental health conditions and unemployment. Psychiatric conditions interacted with macroeconomic conditions such that those with pre-existing alcohol-related, and neurotic and adjustment disorders were disproportionately more likely to become unemployed following the 1990s crisis in Sweden. CONCLUSIONS: Adolescent mental health conditions forecast an elevated risk of unemployment, which endures over the life course and is amplified in times of economic uncertainty. Investment in youth mental health services and alcohol and substance use prevention programs may yield economic benefits by reducing unemployment.

The scarring effect of unemployment on psychological well-being across Europe.

Past unemployment may have a pervasive psychological impact that occurs across nations. We investigate the association between unemployment events across working life and subsequent psychological well-being across 14 European countries. Additionally, we consider the influence of between-country differences in labour market institutions and conditions on the cross-country well-being effects of unemployment. Data detailing life-long employment trajectories and contemporary life conditions are drawn from the Survey of Health, Ageing and Retirement in Europe. The well-being impact of unemployment is modeled using linear, multi-level specifications. Each six-month spell of past unemployment is found to predict reduced quality of life and life satisfaction after the age of 50, having adjusted for a broad range of individual and country-specific covariates. In contrast, the impact of past unemployment on depression is explained by individual demographic factors. We identify the first comparative long-term evidence that unemployment welfare scarring may be a broad, international phenomenon.