Low-quality employment trajectories and mental health disorders among Swedish and migrant workers

AIM: This study aims to examine the effects of low-quality employment trajectories on severe common mental disorders (CMD) according to Swedish and foreign background. METHODS: This is a longitudinal study based on Swedish population registries (N = 2,703,687). Low- and high-quality employment trajectories observed across five years (2005-2009) are the exposure with severe CMD as outcome (2010-2017). Adjusted hazard ratios (HR) were calculated using Cox regression stratified according to background (first-generation (i) EU migrants, (ii) non-EU migrants, (iii) second-generation migrants, (iv) Swedish-born with Swedish background) and sex. The reference group were Swedish-born with Swedish background in a Constant high-quality employment trajectory. RESULTS: Second-generation migrants had an increased risk of CMD compared to Swedish-born with Swedish background when following low-quality employment trajectories (e.g., male in Constant low-quality HR: 1.53, 95% CI: 1.41-1.68). Female migrant workers, especially first-generation from non-Western countries in low-quality employment trajectories (e.g., Constant low-quality HR: 1.65, 95% CI:1.46 - 1.87), had a higher risk of CMD compared to female Swedish-born with Swedish background. The confidence interval for CMD risk showed little differences between migrant groups (1st and 2nd generation) compared to the reference group. CONCLUSIONS: Low-quality employment trajectories appear to be determinants of risk for CMD, having a differential impact according to background of origin and sex. We observe a higher risk for severe CMD across migrant groups, especially second-generation migrants, compared to Swedish-born with Swedish background. Further qualitative research is recommended to understand the mechanism behind the differential mental health impact of low-quality employment trajectories according to foreign background. KEY MESSAGES: • First and second-generation migrants in low quality employment have higher risk of severe common mental disorders compared to Swedish born with Swedish background workers in low quality employment. • Policies targeting working conditions in low-quality employment and promoting workers mental well-being are essential to reduce this higher risk for developing CMD, especially for migrant populations.