Peer-reviewed article
Caregiving and Work: Labour Market Outcomes in Spouses of Patients With a Mental Illness-A Danish Nationwide Matched Cohort Study.
Mikkelsen LJ, Hjorthøj C, Nielsen SS, Benros ME, Müller AD et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examines how parental mental illness affects the work and income of spouses in Danish families with dependent children. Using national register data from 2010-2022, researchers compared 54,080 spouses of people with mental disorders to matched controls. Spouses of people with mental illness had lower income and employment levels and received more sickness benefits, with effects persisting for five years after diagnosis. The impacts differed by sex, with men experiencing greater income loss and women facing greater employment reduction.
Key points
- Spouses of individuals with mental illness had 16% lower annual income five years after the partner's diagnosis
- Degree of employment was 12 percentage points lower for cases compared with controls at five years
- Odds of receiving sickness benefits increased markedly in the year following the partner's diagnosis
- Male spouses experienced larger relative income loss; female spouses had greater reductions in employment and higher sickness benefit receipt
- Labour market disadvantages were substantial and sustained even within Denmark's universal welfare system
Limitations
This study focuses on adult economic outcomes in families with a mentally ill parent, not on child well-being, health outcomes, or development. It cannot tell us about the actual impact of parental mental illness on children's survival, development, protection, or participation outcomes.
Abstract
Objectives To examine labour market outcomes among spouses of individuals with a hospital-recorded diagnosis of a mental disorder living with dependent children, compared with matched controls, and to assess whether these associations differ by sex. Methods We conducted a nationwide, register-based matched cohort study using data from Danish population registers from 2010 to 2022. Cases were spouses cohabiting with an individual diagnosed with a mental disorder and with at least one child aged 0-17 years living at home at the index date. Controls were matched 1:10 on age, sex, and cohabitation status and had no partner with a registered mental disorder at the index date. Outcomes were taxable income, degree of employment (percentage of full-time employment), and receipt of sickness benefits, assessed from 5 years before to 5 years after the index date. Analyses used fixed-effects linear models and conditional fixed-effects logistic regression with both unadjusted and covariate-adjusted estimates, and sex-by-case status interactions were examined. Results The study included 54,080 cases and 468,541 matched controls. Across the observation period, spouses of individuals with mental illness had persistently lower income and degree of employment and higher odds of receiving sickness benefits than controls. Five years after the index date, cases had a 16% lower annual income and a 12 percentage point lower degree of employment compared with controls. Odds of receiving sickness benefits increased markedly in the year following the partner's diagnosis. Sex-specific analyses showed that male spouses experienced larger relative income loss, whereas female spouses exhibited greater reductions in degree of employment and higher absolute levels of sickness benefit receipt. Conclusions Spousal mental illness is associated with substantial and sustained labour market disadvantages in families with dependent children, even within a universal welfare system. The observed sex-specific patterns suggest that caregiving-related economic consequences are structured along sex-specific divisions of labour. These findings highlight the need to consider spouses in policy responses to mental illness.