(PS3-A12) The Relationship Between Social Anxiety, Depression, and Employment in a Sample of Diverse Job Seekers

Background: Both social anxiety disorder and depression are common among those who are unemployed. These disorders may be part of a vicious cycle with unemployment: avoidance and inactivity make obtaining and maintaining employment harder, while continued unemployment may worsen anxiety and depression symptoms. For example, being unemployed likely limits the amount of exposure to social interactions and activity that an individual has each day and both social interactions and activity are beneficial for mental health. In fact, gold standard psychosocial treatments for anxiety and depression primarily address these issues: exposure therapy for social anxiety (Rodebaugh et al., 2004) and behavioral activation for depression (Cuijpers et al., 2014). The present study examines the relationship between social anxiety, depression, and employment in a longitudinal study of a large and diverse sample of job seekers with social anxiety. Specifically, we test the hypothesis that as individuals’ employment improves symptoms of social and anxiety and depression will decrease.  

Methods: Participants (N=242 adults) were part of a two-site randomized controlled trial investigating the effect of work-related group cognitive behavioral therapy (WCBT) plus vocational services as usual (VSAU) on employment and mental health outcomes. Participants were randomized to receive WCBT + VSAU or VSAU alone. Participants completed measures of social anxiety directly after the intervention, and 8, 22, and 48 weeks after the intervention. Additionally, participants responded to biweekly texts following the intervention indicating the number of hours they worked for pay the previous two weeks.

Analysis and

Results: We examined relationships between depression, social anxiety, and average hours worked over a 48-week period (4 timepoints), using expectation maximization to estimate missing data and robust standard errors. Results demonstrated that work hours significantly predicted subsequent depression severity at one time point (at time 4, β= -0.050, SE=0.022, z= -2.253, p=.024) in the expected direction (i.e., more time working predicted less depression). Additionally, there was a trend toward social anxiety predicting subsequent work hours at one time point (at time 4, β= -0.033, SE=0.019, z= -1.771, p=.077) in the expected direction. Depression and social anxiety also subsequently predicted each other (e.g., path from depression at time 3 to anxiety at time 4, β= 1.092, SE=0.343, z= 3.188, p=.001).

Discussion: While preliminary, these analyses demonstrate that in a real-world community sample, consisting of participants with numerous comorbidities and additional barriers such as homelessness and discrimination, there may be a cyclical relationship between work, depression, and social anxiety. This suggests benefits of mental health treatment in increasing employment, as well as benefits from employment in decreasing negative mental health outcomes. Additional analyses will look at the overall relationship between these three variables and identify potential moderating factors. Clinical implications of these findings will discussed, including the potential value of increasing employment as a treatment mechanism.