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A new study from Princeton University indicates many prime-age men are no longer in the labor force because of a serious health condition, a factor that may help explain the decline in the labor participation rates in the United States.

The paper, titled “Where Have All the Workers Gone? An Inquiry Into the Decline of the U.S. Labor Force Participation Rate,” by Princeton economist Alan B. Krueger said nearly half of prime age men not in the labor force take pain medication on a daily basis, and nearly two-thirds of them take prescription pain medication.

The paper says labor force participation has fallen more in areas where relatively more opioid pain medication is prescribed.

Prime age men who are out of the labor force report that they experience notably low levels of emotional well-being throughout their days and that they derive relatively little meaning from their daily activities.

Forty-three percent of prime age men who are out of the labor force reported their health as fair or poor, compared with just 12% of employed men and 16% of unemployed men.

The paper said:

While it is certainly possible that extended joblessness and despair induced by weak labor demand could have caused or exacerbated many of the physical, emotional and mental health-related problems that currently afflict many prime age men who are out of the labor force, the evidence suggests that these problems are a substantial barrier to work that would have to be addressed to significantly reverse their downward trend in participation.

The labor force participation rate in the United States has declined since 2007, primarily because of population aging, as well as trends that preceded the recession that began in December 2007.

The labor force participation rate in the United States peaked at 67.3% in early 2000, and it has declined since then, reaching a near 40-year low of 62.4% in September 2015.