Mental and physical health changes around the onset of health-related economic inactivity in the UK

Background

Transitions into health-related economic inactivity can have lasting impacts on health trajectories. These impacts are of particular concern in the United Kingdom which has seen an unprecedented rise since 2019 in rates of long-term sickness. This study investigates mental and physical health trajectories by age before, during, and after the onset of health-related economic inactivity among working-age adults in the UK.

Methods

We used Waves 1-15 (2009-2025) of the UK Household Longitudinal Study for adults aged 16-64. Propensity score matching compared those who experienced health-related inactivity with similar individuals who did not. Piecewise growth curve models estimated trajectories of SF-12 Mental (MCS) and Physical (PCS) Component Summary scores across pre-onset, onset, and post-onset periods, stratified by age group and subsequent labour market status.

Results

Pre-onset, physical health declined by 1.0-1.3 points annually across ages (e.g., PCS, 50-64: -1.11 [95% CI: -1.24,-0.98]), while mental health dropped most steeply for the youngest age group (MCS, 16-29: -1.42 [-1.88,-0.97]). Following sharp declines at onset of inactivity, subsequent employment was associated with substantial health recovery, particularly for ages 50–64 (PCS: 12.37 [9.19,15.56]; MCS: 9.83 [6.13,13.53]). However, this boost was not sustained; those in employment experienced significant secondary declines (PCS, 50-64: -6.99 [-8.97,-5.01]), whilst unemployment had no initial recovery and continued health declines.

Conclusions

Pre-onset declines reveal a window for early health intervention, with mental health deteriorating faster than physical health for some ages. Initial gains from rapid (re-)entry into employment are not sustained long-term, whilst transitions into unemployment show no such recovery. Post-onset trajectories don’t return to those of matched counterparts, suggesting longer-term ‘scarring’ from health-related inactivity, despite labour market recovery.

Key messages

• Health declines begin well before health-related economic inactivity starts, identifying a critical window for early workplace and clinical interventions to prevent long-term labour market exits.

• Initial health gains from returns to work are not sustained long-term, highlighting needs for ongoing health support in the workplace and integration into employment services for those out of work.