Low-quality employment trajectories and the risk of common mental health disorders among individuals with Swedish and foreign background - a register-based cohort study

Abstract

Objective: This study aimed to examine the effects of low-quality employment trajectories on severe common mental disorders (CMD) according to Swedish and foreign background.

Methods: In this longitudinal study based on Swedish population registries (N=2 703 687), low- and high-quality employment trajectories were the main exposures observed across five years (2005-2009), with severe CMD as outcome variable (2010-2017). Adjusted hazard ratios (HR) were calculated by means of Cox regression models and stratified according to Swedish and foreign background [first-generation (i) EU migrants, (ii) non-EU migrants, (iii) second-generation migrants, (iv) Swedish-born of Swedish background] and sex. The reference group was Swedish-born of Swedish background in a constant high-quality employment trajectory.

Results: Second-generation migrants had an increased risk of CMD compared to Swedish-born of Swedish background when following low-quality employment trajectories [eg, male in constant low-quality HR 1.54, 95% confidence interval (CI) 1.41-1.68]. Female migrant workers, especially first-generation from non-EU countries in low-quality employment trajectories (eg, constant low-quality HR 1.66, 95% CI 1.46-1.88), had a higher risk of CMD compared to female Swedish-born of Swedish background. The risk for CMD according to employment trajectories showed little differences between first- and second-generation migrants.

Conclusion: Low-quality employment trajectories appear to be determinants of risk for CMD in association with Swedish or foreign background of origin and sex. Our study shows a higher risk for severe CMD in second-generation and non-EU migrant compared to Swedish-born of Swedish background in constant low-quality employment. Further qualitative research is recommended to understand the mechanism behind the differential mental health impact of low-quality employment trajectories according to foreign background.

Figure 1

Adjusted hazard ratios (HR) and 95% confidence intervals (CI) for severe common mental disorders (CMD) (2010–2017) according to employment trajectories (2005–2009) and stratified by sex and background of origin (N=2 703 687). The reference group is Swedish born and of Swedish background (Swedish—born SB). The covariates used for adjustment were age, education, marital status, parental mental disorders, parental socioeconomic position, previous mental disorders, duration of time after migration. All covariates have been included in their 2005 version. Second Gen=second generation migrants born in Sweden; 1st Gen EU=first-generation EU migrants (EU-28, Nordic countries and North America, Oceania). 1st Gen Non EU=first generation non-EU migrants (Asia, Africa, South America, former Soviet Union).