Background: The ecological association between contracting labor markets and admissions to inpatient psychiatric treatment has been widely replicated, but little understood, in the United States. Its explanations include the "uncovering mechanism" that assumes a contracting labor market does not increase the incidence of illness, but rather decreases the ability of chronically ill persons or their families to pay the direct and indirect costs of outpatient care. Without such care, some of these persons supposedly become more ill and eventually require inpatient treatment subsidized by the state. This explanation would not apply to a society with universal access to high quality mental health services. The uncovering mechanism, therefore, would be less compelling if the ecological association were found in such a society. We apply time-series methods to data for the 336 months beginning January 1973 to determine if the association appears in Sweden.
Results: Consistent with the findings from the United States, inpatient admissions of Swedish men and women move inversely over time with changes in the number of each employed.
Conclusions: The uncovering mechanism cannot explain the Swedish findings. Its rivals, including the argument that economic contraction either increases the incidence of illness or reduces tolerance for the persistently mentally ill, deserve more attention at least in countries with universal access to care. We offer research strategies for discriminating between these remaining rivals.