Pre-Employment Testing: Failing to Make the Grade

Does the Rising Use of Employment Personality Tests Contribute to An Increase in Suicides?

As stated in a 2013 Newsweek cover story:

Every year since 1999, more Americans have killed themselves than the year before, making suicide the nation’s greatest untamed cause of death. In much of the world, it’s among the only major threats to get significantly worse in this century than in the last. 

There has been an almost 20 percent rise in the annual suicide rate, a 30 percent jump in the sheer number of people who died, at least 400,000 casualties in a decade—about the same toll as World War II and Korea combined. 

In 2013, America is likely to reach a grim milestone: the 40,000th death by suicide, the highest annual total on record. In November 2012, a study lead by Ian Rockett, an epidemiologist at West Virginia University, showed that suicide had become the leading cause of “injury death” in America. As the CDC noted again this spring, suicide outpaces the rate of death on the road—and for that matter anywhere else people accidentally harm themselves.

Public Health Burden of Suicidal Behavior in 2008
Adults 18 and Older
All rates per 100,000 population
Source: CDC's National Vital Statistics System.

Interpersonal Theory of Suicidal Behavior

The interpersonal theory of suicidal behavior holds that an individual will die by suicide if he or she has both the desire for suicide and capability to act on that desire. According to the theory, suicidal desire results from the convergence of two interpersonal states: perceived burdensomeness and thwarted belongingness:

• Perceived burdensomeness is the view that one’s existence burdens family, friends, and/or society.  This view produces the idea that “my death will be worth more than my life to family, friends, society, etc.” – a view, it is important to emphasize, that represents a potentially fatal misperception. Past research, though not designed to test the interpersonal-psychological theory, nonetheless has documented an association between higher levels of perceived burdensomeness and suicidal ideation. 
• Thwarted belongingness is the experience that one is alienated from others, not an integral part of a family, circle of friends, or other valued group. A persuasive case can be made that, of all the risk factors for suicidal behavior, ranging from the molecular to the cultural levels, the strongest and most uniform support has emerged for indices related to social isolation

Desire alone is not sufficient to result in death by suicide--a third component must be present: the acquired capability for suicide, which develops from repeated exposure and habituation to painful and provocative events. These experiences often include previous self-injury, but can also include other experiences, such as repeated accidental injuries; numerous physical fights; and occupations like physician and front-line soldier in which exposure to pain and injury, either directly or vicariously, is common.

The diagram below sets out a visual representation of the interpersonal theory of suicide. The intersection of perceived burdensomeness and thwarted belongingness creates a desire for suicide. The intersection of that area and the capability for suicide creates the circumstances for suicide or near-lethal suicide attempt.

Expanding Use of Personality Tests and Potential Impact on Suicides

Studies have shown that being unemployed was associated with a twofold to threefold increased relative risk of death by suicide, compared with being employed. Given that more than 90% of persons who attempt suicide have mental illnesses, a process like the use of personality testing that results in persons with mental illnesses being excluded from employment consideration can lead to an increase both in (i) perceived burdensomeness and, (ii) as a consequence of not being employed, thwarted belongingness/social alienation. This happens both on an individual and aggregate level and may cause an increase in suicides.

To date, employment personality assessments have been used primarily in the context of recruitment and hiring for entry-level positions. Assessment use is expanding to a variety of employment actions, including promotion, leadership development, training, retention, succession planning, outplacement, and restructuring.

The possible knock-on impacts of the broadening use of assessments includes the potential that existing employees with mental illness (whether diagnosed or not), many of whom became employees prior to the widespread use of assessments in the hiring process, will find themselves unemployed and, as a consequence, having greater feelings of burdensomeness and thwarted belongingness. This, in turn, may lead to more suicides.

Tests Discriminate Against Returning Veterans

As our armed forces demobilize from wars in Iraq and Afghanistan, a material segment of veterans returning to the civilian workforce - those soldiers suffering from post-traumatic stress disorder (PTSD) - will face challenges finding employment in the private sector.

After more than a decade of war, many U.S. military veterans have lived through extended periods of combat stress and the trauma of losing colleagues. Nearly one in five of the troops returning from Iraq and Afghanistan suffer from PTSD, according to a 2008 study by the Rand Corp. By contrast, a  national survey, conducted between February 2001 and April 2003, estimated lifetime prevalence of PTSD among adult Americans to be 6.8% - about one-third of the percentage of troops returning from Iraq and Afghanistan.

PTSD is an anxiety disorder that can develop in response to exposure to an extreme traumatic event. These traumatic events may include military combat, violent personal assaults, terrorist attacks, natural or man-made disasters, or serious accidents. The trauma can be directly experienced or witnessed in another person, and involves actual or threatened death, serious injury or threat to one's physical integrity. The person's response to the event is one of intense fear or helplessness.

High levels of neuroticism have been consistently correlated with PTSD. As noted in the ADA, FFM and DSM post, an employers profile for its assessment testing looks for low levels of neuroticism. Consequently, an FFM-based assessment screens out those suffering from PTSD from employment consideration. 

Numbers support the screening out of returning veterans. According to a recent Department of Labor report, the unemployment rate for male Gulf War II-era veterans (those serving at any time since September 11, 2001) age 18 to 24 was 20.0 percent. Pre-employment assessment testing is more broadly utilized as part of the recruiting and hiring process for entry-level positions, thus the focus on the 18-24 year old cohort.

In addition, when the Society for Human Resource Management surveyed its members in June 2010, 46% of respondents said they believed PTSD and other mental health issues was the third most significant challenge of hiring returning veterans.

A June 2012 report from the Center for a New American Security, a Washington, D.C.-based think tank, found executives from more than half of 69 leading companies had negative stereotypes about veterans because of concerns about combat stress. Gwen Ford, head of the San Jose nonprofit Project Hired that helps the disabled, including veterans, find employment, said companies have told her point-blank: Don't send us veterans with PTSD. "What they then hear from me is the lecture of their life because it's illegal to discriminate against someone with a disability," Ford said. 

Benefits of Employment

Employment enables many people with disabilities and combat-related conditions, including those with PTSD, to fully participate in society. In fact, according to the National Council on Disability, people who regain employment following the onset of a disability report higher life satisfaction and better adjustment than do people who are not employed. 

At the most fundamental level, employment generates income that is vital to individual and family economic well-being. Given how closely our identities are tied to our occupation, employment plays a critical role in maintaining our self-concept. Further, employment affords opportunities to experience success and build self-esteem, which are critical elements toward psychological health. It facilitates social interaction and connections that can reduce the isolation that is commonly experienced through depression and PTSD. For these reasons, gainful employment can be an important component in the recovery and rehabilitation of people with PTSD.

Click for additional information on PTSD resources

Mental Illness and Issues of Employment

How significant is unemployment and underemployment of persons with mental illness?

According to the National Alliance on Mental Illness (NAMI), the unemployment rate among adults with serious mental illness has been as high as 90%, the highest level of any group of people with disabilities.

According to a 2008 report, 16.5% of the population aged 21 to 64 had a disability and only 45.6% of this group was employed. 

According to the chart below from a 2010 Harris Interactive survey, the employment gap between people with and without disabilities remains significant.

An article published in 2010, shows that during the period between October 2008 and June 2010, the proportion of employed U.S. workers identified as having disabilities declined by 9%, while there was no statistically significant change in the number of labor force participants without disabilities. 

According to a 2006 article, one in three mental health consumers in the United States report being turned down for a job once their psychiatric status became known.

Is there bias against persons with mental illness?

According to that 2006 article:

• Surveys of U.S. employers show that half of them are reluctant to hire someone with past psychiatric history or currently undergoing treatment for depression.
• Approximately 70% are reluctant to hire someone currently taking antipsychotic medication. 
• Half of U.S. employers would rarely employ someone with a psychiatric disability and almost a quarter would dismiss someone who had not disclosed a mental illness.
• People with mental disorders identify employment discrimination as one of their most frequent stigma experiences. Compared with individuals with physical disabilities, twice as many people with mental disabilities (the majority) expect to experience employment-related stigma. 

How prevalent is mental illness?

According to a report by the National Institute of Mental Health, an estimated 26.2% of Americans ages 18 and older suffer from one or more brain or behavior disorders in a given year. 

The Brain and Behavior Research Foundation reports that out of the 10 leading causes of disability identified and tracked in the United States; four are brain and behavior disorders: major depression, bipolar disorder, schizophrenia and obsessive-compulsive disorder.

More information on mental illness may be obtained from the National Alliance on Mental Illness, the National Institute of Mental Health, the Brain and Behavior Research Foundation, and the Depression and Bipolar Support Alliance.

What are the costs of unemployment and underemployment of the mentally ill?

Not only does the United States economy experience the indirect loss in productivity arising from the unemployment and underemployment of persons with mental illness, there is a direct, rising and material cost to the U.S. Treasury associated with Social Security Disability Insurance (SSDI) payments to those persons.

According to a 2011 paper, between 1989 and 2009, the share of adults receiving SSDI benefits doubled, from 2.3 to 4.6 percent of Americans ages 25-64. In the same interval, cash payments to SSDI recipients (adjusted for inflation) tripled to $121 billion.  

One of the most common and rapidly expanding diagnoses for individuals receiving SSDI awards is mental illness, which comprised more than 20 percent of SSDI awards over the past decade.  A 2005 study in the New England Journal of Medicine reports that the prevalence of mental disorders in the U.S. population was unchanged between 1990 and 2003 . In the same interval, the rate of treatment of mental illness substantially increased—which in turn should have contributed to improved work-readiness among individuals coping with mental illness.

Over the past twenty years there has been an exponential rise in the number of pre-employment assessments administered to applicants, driven in large part by the increase in the number of applications per job opening arising as a consequence of online postings of job opportunities. The pre-employment assessments, intentionally or not, discriminate against applicants with mental disabilities in the hiring process. As a result, too many people living with mental illness that are willing and able to work remain unemployed or underemployed.