Caregiving and Work: Labour Market Outcomes in Spouses of Patients With a Mental Illness-A Danish Nationwide Matched Cohort Study.

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.